Baseline versus on-treatment heart failure with preserved ejection fraction in a real world cardio-oncology setting: observational analysis of cardiotoxicity and cancer treatment implications
B Von Kemp, X Galloo, B Roosens, B Neyns, R Schots, M De Ridder, B CosynsAbstract
Background
The prevalence of heart failure (HF) with preserved ejection fraction (HFpEF) increases due to improved diagnostic tools and treatments. In cancer patients undergoing potentially cardiotoxic treatments, HFpEF is not included in baseline risk stratification, nor in cancer therapy-related cardiac dysfunction (CTRCD) definitions. Data on HFpEF in this population are scarce.
Purpose
We described baseline HFpEF prevalence in cancer patients, and compared the incidence of cardiotoxic and HF events (CTRCD + HFpEF decompensation) and mortality in this subgroup compared to patients without pre-existing HF and to patients with pre-existing HF(m)rEF. Secondly, we investigated the incidence of HFpEF events (new HFpEF diagnosis or decompensation of pre-existing HFpEF) during or after cancer therapy, identifying predictors for developing on-treatment HFpEF.
Methods & Results
This observational, retrospective real-world analysis included 665 patients (54.1% female, mean age 62.1 years, median follow-up 485 days), of whom 36 (5.4%) had known HFpEF prior to cancer therapy initiation. In this subgroup, 19/36 (52.8%) developed cardiotoxic events, 16/36 (44.4%) developed HF events and 10/36 (27.8%) died. Independent of baseline characteristics, 96/665 patients (14.4%) developed HFpEF events, of whom 46/96 (47.9%) had pre-existing CVD yet only 15/96 (15.6%) a previous HFpEF diagnosis. Cancer therapy required adaptation in 12/96 patients (12.5%). Older age, female sex, arterial hypertension and previous arrhythmias predicted on-treatment HFpEF events in multivariate analysis.
Conclusion
Pre-existing HFpEF carries a significant cardiotoxicity and mortality risk comparable to HF(m)rEF, but is likely underdiagnosed in cancer patients. On-treatment HFpEF events are common and may have important cancer treatment (and prognosis) implications. . Risk predictors for HFpEF events during or after cancer therapy are female sex, symptom referral, age >65 years, AHT, pre-existing arrhythmia and immunomodulatory myeloma therapy. Further investigations are required to evaluate whether specific management strategies may improve prognosis in these patientsGraphic Abstract