Aug 2026· European Heart Journal, Supplement· 0 citations
Abstract
Cardio-oncology patients face an increased risk of chemotherapy-related cardiotoxicity (CTRCD). The Heart Failure Association (HFA)/International Cardio-Oncology Society (ICOS) score is a validated tool for cardiovascular (CV) risk stratification. Although cardiac biomarkers play a key role in CTRCD risk assessment and diagnosis, their availability in routine clinical practice remains limited.
We aimed to compare the performance of the full HFA-ICOS model, incorporating cardiac biomarkers, with biomarker-free models, including a simplified clinical model and a modified model integrating baseline global longitudinal strain (GLS), in anthracycline-treated patients.
We retrospectively analyzed 316 patients treated with anthracyclines across three centers. Baseline CV risk was assessed using the HFA-ICOS score. Three models were evaluated: (1) the full HFA-ICOS model including cardiac biomarkers (troponin and NT-proBNP), (2) the mini-HFA-ICOS model excluding biomarkers, and (3) a modified biomarker-free HFA-ICOS model including baseline GLS. CTRCD was defined according to the 2022 ESC guidelines. Discriminative performance was assessed using recever operating characteristic (ROC) curves, and comparisons between models were performed using DeLong’s test. Risk reclassification analyses were also conducted.
Asymptomatic (27%, 39%, 46%, and 60%; p 0.017) and symptomatic CTRCD (1.3%, 4.6%, 13%, and 40%; p < 0.001) were more frequent in higher risk groups. For all CTRCD definitions, the full HFA-ICOS model showed higher discrimination than the mini model (AUC 0.640 vs 0.604; p = 0.004). When baseline GLS was incorporated into the biomarker-free model, discrimination was numerically improved compared with the mini model (AUC 0.643 vs 0.604; p = 0.0004) and was comparable to the full HFA-ICOS model (AUC 0.643 vs 0.640; p = 0.75), although differences in AUC did not reach statistical significance. When excluding mild asymptomatic CTRCD to minimize biomarker-related circularity, the modified biomarker-free HFA-ICOS model including GLS demonstrated discrimination comparable to the full and mini models (AUC 0.622 vs 0.617; p = 0.87; AUC 0.622 vs 0.605; p = 0.39). Compared with the full HFA-ICOS model, the mini model resulted in risk reclassification in 7.6% of patients, entirely driven by downgrading, whereas inclusion of GLS reduced discordance with the full model (5.1%) and reclassified 3.8% of patients compared with the mini model.
While integration of cardiac biomarkers improves CTRCD risk stratification within the HFA-ICOS framework, baseline GLS provides meaningful incremental value when biomarkers are unavailable or when biomarker-independent CTRCD definitions are applied. GLS may therefore represent a pragmatic alternative to biomarkers for refining cardiotoxicity risk assessment in routine cardio-oncology practice.
A simplified risk score based on readily available clinical and echocardiographic variables for predicting anthracycline-related cardiotoxicity and the RE-ACT score provides additional post-treatment prognostic value is developed and validated and supports a practical 2-step strategy for personalized surveillance in cardio-oncology.
D. Cardinale, Nicola Cosentino, Chiara Morocutti et al.· JACC CardioOncology· 1 citation
Pre-chemotherapy risk assessment using the Heart Failure Association – International Cardio-Oncology Society (HFA-ICOS) score helps identify patients at risk for cancer therapy–related cardiac dysfunction (CTRCD). [1] Oral health is a potentially modifiable factor that may contribute to cardiovascular vulnerability. [2] In the ROOT-CTRCD study, poor oral health was significantly associated with increased risk and delayed recovery of CTRCD in patients receiving HER2-targeted therapy. [3] Poor oral health was also evaluated as an additional point in the HFA-ICOS risk score to assess potential reclassification of risk (Fig. 1).
This post-hoc analysis was conducted using data from the ROOT-CTRCD study. Among 604 patients treated with trastuzumab, 307 completed all planned cycles and had at least one year of follow-up. Patients with prior chemotherapy, major cardiovascular comorbidities, smoking, chronic kidney disease, ischemic heart disease, heart failure, dyslipidaemia, or established risk factors for periodontitis were excluded. The final analysis included 62 patients who developedCTRCDand 65 matched controls. Baseline oral health was assessed using the DMFT index and periodontal staging/grading.Patients were categorized into poor or good oral health groups.Logistic regression and receiver operating characteristic (ROC) analyses were performed, and positive and negative predictive values were calculated to evaluate the predictive value of oral health for CTRCD (Fig. 2).Results:
Poor oral health was more frequent in the CTRCD group (40/62) than in controls (21/65), corresponding to an odds ratio of 3.8 (p < 0.001). ROC analysis of oral health alone yielded an AUC of 0.66, with a positive predictive value of 65.6% and negative predictive value of 66.7%. Incorporation of poor oral health as 1 additional point in the HFA-ICOS risk score would reclassify all previously low-risk patients as intermediate risk, potentially improving sensitivity for identifying patients at risk for CTRCD.
Adding poor oral health to the pre-chemotherapy HFA-ICOS risk score may enhance early identification of patients at increased risk of CTRCD. These results support considering oral health as a modifiable risk factor in baseline cardiovascular risk assessment, and prospective studies are warranted to validate this approach.Figure 1 Figure 2
A. Basuoni, K. Al-Baimani, W. Dawelbeit et al.· European Heart Journal, Supp...· 0 citations
The CARE study is a large prospective observational cardio-oncology study evaluating the incidence of CTRCD after contemporary breast cancer therapy regimens and the performance of the HFA-ICOS risk stratification tool and follow-up strategies in routine cardio-oncology care.
V. Vinje, E. Orstad, G. Gulati et al.· European Heart Journal, Supp...· 0 citations
Cardiotoxicity remains a major limitation of contemporary anticancer therapies. Sodium–glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated cardiovascular benefits, including reduced heart failure hospitalizations, and emerging evidence suggests potential additional benefits in oncology populations. Accurate baseline cardiovascular risk stratification and early initiation of cardioprotective therapy are essential for preventing cancer therapy–related cardiovascular toxicity (CTR-CVT).
We prospectively evaluated 256 patients with breast or lung cancer prior to initiation of anticancer therapy. Baseline cardiovascular assessment included echocardiography with biplane left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), diastolic function, and measurement of cardiac biomarkers (troponin and NT-proBNP). Cardiovascular history, demographic data, and risk factors were collected. CTR-CVT risk was assessed using the HFA-ICOS Cardio-Oncology risk assessment tool.Seventy patients (29 men, 41 women; mean age 69.6 ± 8.0 years) were classified as high risk and initiated on cardioprotective therapy. Forty-seven patients (67.1%) received angiotensin-converting enzyme inhibitors, beta-blockers, statins, and SGLT2 inhibitors (SGLT2i group). Twenty-three patients (32.9%) had contraindications to SGLT2i therapy and received standard cardioprotective treatment. Outcomes were assessed at 6 months.
At 6-month follow-up, no statistically significant changes in systolic or diastolic function were observed in either group. In the SGLT2i group, LVEF and GLS remained stable between baseline and follow-up (median LVEF 60.0% vs. 53.0%, p>0.05; GLS −18.9% vs. −16.8%, p>0.05). Renal function showed a modest numerical decline (median eGFR 80.0 vs. 62.0 ml/min/1.73 m², p>0.05). In patients not receiving SGLT2i, no significant changes were detected in LVEF or GLS, while a numerically greater decline in renal function was observed (median eGFR 95.0 vs. 49.0 ml/min/1.73 m², p>0.05). Diastolic parameters remained stable in the SGLT2i group, whereas a numerical increase in E/e′ medial was observed in the non-SGLT2i group. No heart failure–related hospitalisations or cardiovascular deaths occurred.
In this 6-month longitudinal analysis of oncologic patients at high risk of CTR-CVT, inclusion of SGLT2 inhibitors in a cardioprotective regimen was not associated with adverse cardiac effects. Although statistical significance was not reached, trends toward more stable cardiac and renal parameters were observed. These findings are hypothesis-generating and support further investigation of SGLT2 inhibitors in cardio-oncology.Table showing the following parameters
M. Samardjieva, I. Simova, V. Petrusheva et al.· European Heart Journal, Supp...· 0 citations
Translating the 2022 ESC cardio-oncology recommendations into a structured clinical decision support tool may facilitate standardized cardiovascular assessment and risk-adapted monitoring in patients receiving potentially cardiotoxic cancer therapy.
To develop and present a structured clinical decision support tool implementing ESC recommendations to assist clinicians in baseline cardiovascular (CV) risk stratification and stepwise monitoring during and after anthracycline and HER2-targeted therapy, including post-treatment risk reassessment.
The tool was developed in accordance with the 2022 ESC Cardio-Oncology Guidelines and the HFA-ICOS framework for baseline CV risk stratification, categorizing patients as low, moderate, high, or very high risk. The algorithm integrates routinely available clinical and treatment-related inputs, including patient characteristics, cardiovascular history, comorbidities, ECHO parameters, cardiac biomarkers, and cancer therapy-related factors. For anthracycline-treated patients, cumulative doxorubicin-equivalent dose is incorporated, with a threshold of ≥250 mg/m² triggering intensified monitoring. The application is based on a rule-driven, guideline-based algorithm that processes user-entered data and generates risk-adapted monitoring recommendations in real time. The tool provides therapy-specific, stepwise monitoring schedules before, during, and after cancer treatment and defines guideline-recommended clinical, imaging, and biomarker thresholds prompting escalation.
The developed clinical decision support tool enables rapid and standardized baseline CV risk stratification (Figure 1) and automatically generates individualized, therapy-specific monitoring strategies across the entire treatment trajectory (Figure 2). For each patient, the tool transparently reports the rationale underlying risk category assignment and delivers actionable recommendations regarding the timing and frequency of ECG, echocardiography, and cardiac biomarker assessment. Predefined, guideline-based triggers for both asymptomatic and symptomatic cancer therapy-related cardiac dysfunction activate escalation pathways, including intensified monitoring, initiation of cardioprotective therapy, and multidisciplinary reassessment of oncological treatment. This structured approach supports consistent, reproducible clinical decision-making within routine cardio-oncology practice at the point of care.
This clinical decision support tool operationalizes ESC cardio-oncology recommendations into a reproducible and intuitive format suitable for everyday clinical practice. Standardization of baseline CV risk assessment and longitudinal monitoring may reduce inter-physician variability and facilitate earlier detection of subclinical myocardial dysfunction without introducing additional risk factors beyond current guideline recommendations.Figure 1 Figure 2
Y. Kulmukhanov, Z. Tlegenova, A. Amanova et al.· European Heart Journal, Supp...· 0 citations
Elderly patients with non-Hodgkin lymphoma, or patients with pre-existing cardiovascular comorbidities, are frequently treated with chemotherapy regimens containing non-PEGylated liposomal anthracycline, in order to reduce cardiotoxicity incidence. For patients candidate to anthracycline, the 2022 European Society of Cardiology (ESC) cardio-oncology guidelines recommend risk stratification through established proformas, but their real-world validation for patients candidate to liposomal anthracycline remains limited.
We retrospectively collected data on patients with newly diagnosed non-Hodgkin lymphoma treated with rituximab, cyclophosphamide, non-PEGylated doxorubicin, vincristine, and prednisone (R-COMP) between 2014 and 2025. Baseline demographics, cardiovascular history, echocardiographic and laboratory parameters, and baseline therapy were recorded. Patients were stratified into risk categories according to the Heart Failure Association International Cardio-Oncology Society (HFA-ICOS) score. Outcomes included overall survival (OS), cardiovascular events occurrence (including asymptomatic left ventricular dysfunction, new-onset or worsening heart failure and acute coronary syndrome) and progression-free survival (PFS).
The cohort consisted of 265 patients [median age 73 years (69 – 77); 51% males]; 41% were classified as moderate risk, 55% as high risk, and 4% as very high risk. During a median follow-up of 29 months, 38 patients (14%) died. OS and cardiovascular events occurrence significantly differed across HFA-ICOS risk categories (p=0.005 and p<0.0001, respectively). Very high-risk patients exhibited substantially higher hazards of mortality (HR 5.8) and cardiovascular events (HR 40.4). Cardioprotective therapy at baseline did not influence cardiovascular outcomes.
The HFA-ICOS score effectively stratifies mortality and cardiotoxicity risk among R-COMP–treated patients. These findings support its application in routine treatment of lymphomas requiring anthracycline-based therapy.
M. Camilli, I. Torre, L. Leo et al.· European Heart Journal, Supp...· 0 citations
We use cookies to run the site and, with your consent, for analytics and to show ads.
See our Cookie Policy.
