Jul 2026· Journal of pediatric hematology/oncology· 0 citations· 35 references
Medicine
TL;DR
It is suggested that survivors treated with anthracyclines require systematic surveillance and targeted interventions to address modifiable cardiovascular risk factors and increasing awareness of prior cardiotoxic cancer treatment among survivors and health care providers may facilitate cardiovascular risk reduction.
Abstract
Anthracycline chemotherapy is associated with cardiotoxicity, underscoring the importance of minimizing modifiable cardiac risk factors in affected individuals. This study evaluated cardiac function, prevalence of metabolic syndrome and smoking, and awareness of prior cardiotoxic treatment among adult survivors of childhood cancer treated with anthracyclines at the pediatric oncology service in Iceland between 1981 and 2011 (n=89). Data were collected from medical records, self-reported questionnaires, and clinical assessments conducted between 2016 and 2019. Of 76 eligible survivors, 60 participated (29 females, 31 males; aged 20 to 48 y). Two individuals were excluded before enrollment due to previously diagnosed heart failure. Left ventricular dilation was observed in 15 participants (25%), predominantly mild to moderate, with 1 severe case. The prevalence was lower after BSA indexing. Metabolic syndrome was present in 20% of participants, and 20% reported current smoking. Approximately half of the participants reported undergoing echocardiography within the past 10 years, while only 10% were aware that their cancer treatment could cause cardiotoxicity. These findings suggest that survivors treated with anthracyclines require systematic surveillance and targeted interventions to address modifiable cardiovascular risk factors. Increasing awareness of prior cardiotoxic cancer treatment among survivors and health care providers may facilitate cardiovascular risk reduction.
Anthracyclines remain a cornerstone of breast cancer therapy but carry a significant risk of cancer therapy-related cardiac dysfunction (CTRCD). This study evaluates the incidence of CTRCD in an Indonesian setting using the latest 2022 ESC Cardio-Oncology guidelines, focusing on subclinical markers such as high-sensitivity Troponin I (hs-cTnI), Global Longitudinal Strain (GLS) and Mechanical Dispersion (MD).
This retrospective analytical cohort study involved 98 breast cancer patients treated with anthracyclines at a national referral hospital in Indonesia from July 2018 to February 2020. Clinical assessments, hs-cTnI, and echocardiography (LVEF, GLS, and MD) were performed at baseline, 1, 3, and 6 months. CTRCD was defined per the 2022 ESC criteria.
CTRCD occurred in 74.5% of patients, predominantly as asymptomatic mild cases (63.26%). While symptomatic CTRCD was relatively low (7.14%), asymptomatic dysfunction was detected as early as one-month post-chemotherapy. A significant progressive decline was observed in LVEF (68.2 ± 6.2% to 61.3 ± 8.8%,
p
< 0.001) and GLS (-19.7 ± 2.9% to -17.1 ± 3.5%,
p
< 0.001). Notably, mechanical dispersion significantly increased over time (
p
= 0.029), and median hs-cTnI surged from 1.6 ng/L to 82.2 ng/L (
p
< 0.001) by month 6.
The high incidence of asymptomatic CTRCD underscores the inadequacy of relying on clinical symptoms alone. Integration of hs-cTnI, GLS, and mechanical dispersion monitoring is may be essential for early detection and enables timely cardioprotective intervention.
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
Distinct biomarker patterns were observed across malignancy subgroups, with higher hs-cTnT increases in breast cancer, more prominent NT-proBNP elevation in lymphoma, and higher sST2 values in lung cancer.
L. Kajanto, D. Stănculeanu, Anca Chisoi et al.· Cardio-Oncology· 0 citations
GLS and LVEF were the most sensitive echocardiographic parameters for differentiating between groups with and without cardiotoxicity, showing consistent changes throughout the study.
R. M. Figueiredo De Sousa, V. Fonseca, M. Henriques et al.· European Heart Journal, Supp...· 0 citations
Diastolic dysfunction appears to be a clinically relevant and potentially early marker of anthracycline-induced cardiotoxicity in breast cancer patients, and earlier recognition may support closer cardio-oncology surveillance, improve risk stratification, and help identify patients who may benefit from earlier specialist evaluation and consideration of cardioprotective strategies before overt systolic dysfunction develops.
T. Mainka, Emil Sergejuk, W. Kotlarski et al.· International Journal of Inn...· 0 citations
A significant decline in right ventricular function is demonstrated during anthracycline-based cardiotoxic therapy and persisting up to one year after treatment completion, even in patients with low cardiotoxic risk, despite changes being subclinical and largely within normal ranges.
I. G. Dimova, G. Petkovska, I. Ismaili et al.· European Heart Journal, Supp...· 0 citations
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