Clinical characterization of cardio-oncology assessment and screening in oncologic patients receiving high toxicity chemotherapy evaluated in a tertiary care center: a retrospective cohort study
Authors: Miranda-Arboleda A F , Regino-Agamez C , Cardona-Velez J , Bello-Simanca J , Gamboa-Arroyave J G , Jaimes-Barragan F 
Published: October 2021

Abstract

Introduction
Cardiovascular disease is the main cause of death in the world, cancer represents an increasing problem and is the second leading cause of death globally. Survival in patients with cancer has increased, and cardiovascular death is the main cause of death in cancer survivors and cardiovascular morbidity secondary to cardiovascular toxicity is an issue of concern. We aimed to describe the clinical characteristics and cardio-oncologic assessment in patients receiving high toxicity chemotherapy.

Methods
Retrospective unicentric cohort study between January 1st, 2017 to December 31st, 2019, all medical records from patients with solid or hematological malignancies were reviewed. Descriptive information regarding demographic characteristics, most common neoplasms and chemotherapeutic agents, adequacy of prechemotherapy cardiovascular assessment, and cardiovascular outcomes were obtained. Prechemotherapy risk of cardiovascular complications using was evaluated using Mayo Clinic risk score to classify patients in different risk categories.

Results
499 patients were included (figure), mean age was 58 years-old (18 - 97), 58% were female. Most common neoplasm was non-Hodgkin lymphoma in 108 patients (21.6%), followed by breast cancer in 97 (19.4%). Most common chemotherapeutic agents were cyclophosphamide in 43.8%, doxorubicin 35.2%, rituximab 23.2%, vincristine 16.2%, paclitaxel 13.8), cytarabine 11.8%), etoposide 11.6%, cisplatin 11.4%, 5-Fluorouracil 10.6%, and bortezomib 9.81%. 18.6% of patients ha chest radiation with a mean dose of 5222 cGy (SD 2072). Trastuzumab associated regimens were scarce and used in 11 patients.
Using the Mayo Clinic Risk Score, most patients had a very high risk of cardiotoxicity 44.1%, 90% of patients did not have cardiology assessment. Regarding cardiovascular work-up prechemotherapy echocardiogram was obtained in 65% in the total population, but in 84% of those in higher risk, baseline electrocardiogram in 57%, follow-up echocardiography in 19.4%, metabolic panel in 10.6%, and cardiac biomarkers in 3% of cases. Global longitudinal strain (GLS) was reported only in 23.7% of patients in the first and 32% of follow-up echocardiograms.
Systolic dysfunction related to chemotherapy developed in 4.4% of patients, all of the symptomatic and over 50 years, rhythm disturbances were present in 2.8% with atrial fibrillation and flutter as the most common arrhythmias, and 16% of patients died from all-cause during follow-up (Table).

Conclusion
Despite the recognized potential toxicity of chemotherapeutics drugs, patients receiving high toxicity regimens and at very high risk of cardiovascular complications are not assessed by cardiology previously and cardiovascular workup was underused. Systolic dysfunction was the most common cardiovascular complication. Implementation of cardio-oncology programs will lead to identifying high-risk patients to detect and treat early these complications.

Funding Acknowledgement
Type of funding sources: None. Study populationOutcomes classified by risk category