Aug 2026· European Heart Journal, Supplement· Vol 28· 0 citations
TL;DR
The authors' prospective registry involving unselected cancer patients with high incidence of metastases revealed high mortality in patients with suspected cardiotoxicity, with a relatively low incidence of 9.8% cardiovascular death.
Abstract
Anticancer treatment-induced cardiovascular cardiotoxicity is related to cardiovascular and all-cause mortality in patients with cancer. We have evaluated the association between echocardiographic findings and all-cause mortality, especially cardiovascular mortality in our cardio-oncologic patient cohort.
Totally 674 patients were included into our Cardio-Oncologic Registry, who visited our cardio-oncologic outpatient care due to suspicious cardiotoxicity. Clinical data (age, sex, date of visit, survival status, date of death, atrial fibrillation) baseline and follow-up echocardiographic data and type of cancer, routine laboratory parameter (among others troponin T, NT-proBNP, creatine), and the main oncologic diagnosis with ICD codes (retrieved from the hospital documentation) were recorded at the baseline and the at the final visiting date.
The mean age of the 674 patients (346 male /51.3%/ and 328 female /48.7%) was 71±13.1 years. Permanent atrial fibrillation was recorded in 156 patients (21.3%). High proportion of patients (n=450, 66.8%) had already metastases at the first visit. Baseline echocardiography was performed in 516 (76.6%) patients, while 316 patients (46.9%) underwent follow-up echocardiography. Left ventricular function worsened in 81/316 patients (25.6%) during the mean follow-up time of 24±12 months. Both the troponin T and NT-proBNP values were already elevated at the first clinical visit, while the mild reduced kidney function did not change. Totally 204 patients (30.3%) died during the 35.2 ±18.5 months visit duration. According to the Austrian Mortality Statistics, 20 of 204 patients (9.8%) died due to cardiovascular complications. Table 1 lists the clinical, laboratory and echocardiographic data of the survival and non-survival patients.
Our prospective registry involving unselected cancer patients with high incidence of metastases revealed high mortality in patients with suspected cardiotoxicity, with a relatively low incidence of 9.8% cardiovascular death.Table 1
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
AIM
To evaluate the prognostic value of the CHA2DS2-VASc score in relation to major adverse cardiovascular events (MACE) and cardiovascular mortality in patients with non-ST elevation myocardial infarction (NSTEMI), and to assess its association with clinical and echocardiographic characteristics.
METHODS
This prospective, observational, cohort study included 311 NSTEMI patients admitted to the Internal Medicine Clinic at the University Clinical Centre Tuzla between January 2023 and April 2024. The patients were stratified into intermediate-risk (score < 4) and high-risk (score ≥ 4) groups based on the CHA2DS2-VASc score at admission. Demographic, clinical, and echocardiographic data were collected, including electrocardiography (ECG) and transthoracic echocardiography. All patients were followed for 3 months (90 days) to assess the occurrence of MACE and cardiovascular mortality.
RESULTS
The patients in the high-risk group were older and had significantly lower left ventricular ejection fractions and larger left atrial diameters compared with the intermediate-risk group. During the 3-month follow-up, MACE occurred in 11.9% of high-risk and 3.9% of intermediate-risk patients; cardiovascular mortality was observed exclusively in the high-risk group (2.5%). A higher CHA2DS2-VASc score was significantly associated with cardiovascular mortality (p = 0.003), but not with overall MACE (p = 0.393). Moderate predictive accuracy for mortality (AUC = 0.64) and shorter event-free survival in the high-risk group (log-rank p = 0.005) were observed.
CONCLUSION
The CHA2DS2-VASc score showed potential as a simple and accessible tool for early identification of NSTEMI patients at risk of cardiovascular death. Its significant association with mortality supports its role as a supplementary risk stratification tool, although these findings require validation in larger, multicentre studies.
Minela Bećirović, E. Bećirović, Amir Bećirović et al.· Medicinski glasnik· 0 citations
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.
Background
Cirrhotic cardiomyopathy remains under-recognized in Southeast Asia, where chronic viral hepatitis and alcohol-related liver disease frequently coexist. The prognostic relevance of the updated 2020 Cirrhotic Cardiomyopathy Consortium (CCC) criteria, particularly the use of global longitudinal strain (GLS), has not been adequately studied in this region.
Objectives
We aimed to characterize cardiac dysfunction in Myanmar patients with cirrhosis, compare the diagnostic performance of the 2005 and 2020 CCM criteria, and determine cardiac predictors of 1-year mortality.
Methods
In this prospective cohort study, 200 consecutive cirrhotic patients underwent comprehensive echocardiography with speckle-tracking analysis and standard electrocardiography. The primary endpoint was all-cause mortality at 12 months. Multivariable Cox regression was used to identify independent predictors of death.
Results
The mean age was 54±11 years. Alcohol-associated liver disease (35%), hepatitis C (30%), and hepatitis B (25%) were the predominant etiologies. Although left ventricular ejection fraction was preserved, GLS was frequently impaired (mean −16.2±3.4%). The 2020 CCC criteria identified cirrhotic cardiomyopathy in 28% of patients compared with 54% by the 2005 criteria. Thirty patients (15%) died during follow-up. GLS <16% (HR 2.10, p<0.001) and QTc prolongation >440 ms (HR 1.75, p=0.018) were independently associated with mortality after adjustment for MELD score.
Conclusions
Subclinical myocardial dysfunction is common among Myanmar patients with cirrhosis. The 2020 CCC criteria demonstrate improved prognostic discrimination. Both impaired GLS and QTc prolongation independently predict mortality and should be incorporated into routine risk stratification.
Swe Min Oo, Myint Zaw, Tun Naing Oo et al.· International Journal of Med...· 0 citations
Cancer patients with pulmonary embolism (PE) have substantial short- and long-term mortality. Echocardiography is central to PE risk stratification, while strain imaging, by detecting subtle myocardial abnormalities, has several advantages over conventional echo parameters.
We aimed to evaluate the prognostic impact of RV functional assessment, with a focus on myocardial deformation imaging, in oncologic patients with acute PE hospitalized in a tertiary care center.
We retrospectively included consecutive cancer patients with PE hospitalized in our department between 2016 and 2025, who underwent echocardiographic assessment, including RV global longitudinal strain (RV-GLS) and RV free wall longitudinal strain (RVFW-LS). PE was classified as high-risk or non-high risk according to ESC criteria. The primary endpoint was in-hospital death. A predefined subgroup analysis was performed in patients with preserved TAPSE (≥ 17 mm).
217 patients were included in the study; 13 (6%) died during hospitalization. Patients who died had lower blood pressure (BP) on admission (p=0.006), higher pulmonary artery systolic pressure (PASP, p=0.01), and significantly more impaired RV function (p=0.008 for TAPSE, p<0.001 for S wave, RV-GLS, RVFW-LS).
25 patients had high-risk, while 192 patients had non-high risk PE. Among non-high risk patients, there were 7 deaths (4%). In univariable analysis, TAPSE, S wave, RV-GLS, RVFW-LS predicted in-hospital mortality for non-high risk patients. In ROC analysis, the strongest predictors of death were RVFW-LS and RV-GLS (AUC=0.93, p=0.001 for both). Both RV strain components remained independet event predictors after adjustment for age, systolic BP and PASP: OR=1.61 [95% CI, 1.13-2.29], p=0.008 for RV-GLS, OR=1.35 [95% CI, 1.08-1.67], p=0.007 for RVFW-LS.
Moreover, in the subgroup of non-high risk patients with preserved TAPSE (n=160), RV-GLS and RVFW-LS remained death predictors (OR=1.30 [95%CI, 1.00-1.69], p=0.05 and OR=1.26 [95%CI, 1.03-1.54], p=0.02, respectively).
In cancer patients with non-high risk PE, RV strain identifies a vulnerable subgroup with increased in-hospital mortality, even when TAPSE is preserved. Strain analysis may improve risk stratification for this population and thus guide intensified monitoring and individualized treatment strategies.
A. Vijiiac, A. Slobodeanu, D. Sararu et al.· European Heart Journal, Supp...· 0 citations
Background: The increasing use of routine oncological imaging has led to more frequent detection of incidental pulmonary embolism (PE), potentially modifying the contemporary clinical presentation of cancer-associated pulmonary embolism (CAPE). Methods: We performed a retrospective cohort study including 381 consecutive patients hospitalized with acute PE, of whom 58 had active cancer and 323 had no active malignancy. The primary endpoint was a Severe Hemodynamic Presentation Composite Endpoint (SHPCE), defined as shock, systolic blood pressure < 90 mmHg, and/or high-risk PE according to European Society of Cardiology criteria. Clinical characteristics, severity markers, management strategies, and in-hospital outcomes were compared between patients with CAPE and non-cancer PE (NCPE). Multivariable logistic regression analyses were performed to evaluate factors associated with SHPCE and incidental PE. Results: The patients with CAPE had higher PESI (129.8 ± 29.3 vs. 110.1 ± 32.3; p < 0.001) and sPESI scores (3.03 ± 0.56 vs. 2.68 ± 0.81; p < 0.001), and lower hemoglobin levels (11.7 ± 1.9 vs. 13.2 ± 1.8 g/dL; p < 0.001). Incidental PE was more frequent in CAPE than NCPE cases (13.8% vs. 1.9%; OR 8.45, 95% CI 2.81–25.39; p < 0.001). Despite their higher baseline risk scores, patients with CAPE and NCPE showed similar rates of SHPCE (12.1% vs. 17.6%; p = 0.295), ICU admission (10.3% vs. 11.5%; p = 1.000), and in-hospital mortality (10.3% vs. 11.1%; p = 0.858). In multivariable analyses, right ventricular dysfunction (RVD) showed the strongest association with SHPCE (adjusted OR 10.21, 95% CI 5.34–19.52; p < 0.001), whereas active cancer was not associated with severe presentation. Conclusions: Active cancer was associated with higher clinical risk scores and a greater prevalence of incidental PE but not with increased hemodynamic severity or adverse in-hospital outcomes. Acute PE severity appeared to be more closely related to right ventricular involvement than to cancer status, supporting a severity-based rather than cancer-based approach to risk assessment.
Călin Pop, V. Manea, L. Pop et al.· Journal of Clinical Medicine· 0 citations
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