Cancer Therapeutic Related Cardiac Dysfunction Among Active Breast Cancer Patients: A Cardio-Oncology Registry

Background: Progress in the treatment of breast cancer during the past two decades has led to substantial improvement in survival but at the cost of increased side effects, with cardio-toxicity being the most significant one with a mortality rate reaching as high as 60% in two years. The most commonly used definition is cancer therapeutic related cardiac dysfunction (CTRCD), defined as a left ventricular ejection fraction (LVEF) reduction of >10 %, to a value below 50%. Latest studies have implied that the incidence of CTRCD among breast cancer patients is decreasing resulting from the lower doses of anthracyclines and lower correlation for Trantszumab and Pertuzumab treatment.

Objectives: Evaluating the incidence of CTRCD among breast cancer patients and identifying significant predictors for its development.

Methods: Data was collected as part of the International Cardio-Oncology Registry (ICOR), enrolling all patients evaluating in the cardio-oncology clinic in our institution. All patients performed at least two echocardiograms.

Results: Among 103 consecutive patients, 5 (5%) developed CTRCD and 10 (10%) developed LVEF reduction of 5% and above. Mean time for CTRCD development was 171days (range 66 to 231). There were no significant differences in the baseline cardiac risk factors (hypertension, diabetes, hyperlipidemia or smoking) between the groups. Significant predictors for developing CTRCD were treatment with Trantszumab (80% vs. 18%, p=0.001) or Pertuzumab (80% vs. 14%, p<0.001) and low systolic blood pressure (100±13 vs. 132±22, p=0.006). Interestingly, Doxorubicin was not. Significant predicting echocardiography parameters included lower baseline global longitudinal strain (GLS) (18± 3 vs. 21±2, p=0.016), increased left ventricular end systolic diameter (LVESD) and low e’ septal. (Table 1)

Conclusions: CTRCD is frequent among active cancer patients and relates to Trantszumab and Pertuzumab treatment. Early GLS evaluation may identify it and allow cardio-protective treatment in order to prevent it.

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