Cardiotoxicity patterns and outcomes in cardio-oncology: differences between hematologic and solid malignancies

Background

Patients referred to cardio-oncology clinics constitute a heterogeneous population in whom cardiovascular risk profile, cardiotoxicity manifestations and outcomes may vary according to malignancy type. Comparative data between hematologic malignancies and solid tumors remain limited.

Purpose

To compare baseline cardiovascular characteristics, cardiotoxicity patterns and clinical outcomes between patients with hematologic malignancies and solid tumors.

Methods

Single-centre retrospective study of consecutive patients evaluated in a cardio-oncology clinic. Baseline clinical characteristics, cardiotoxicity and mortality were compared between malignancy types. Major adverse cardiovascular events (MACE) were defined as cardiovascular death, hospitalization for heart failure, myocardial infarction, new-onset left ventricular dysfunction or clinically significant arrhythmia. Multivariable logistic regression and Kaplan–Meier survival analyses were performed.

Results

A total of 129 patients were included, 24 (18.6%) with hematologic malignancies and 105 (81.4%) with solid tumors. Patients with hematologic malignancies were more frequently male (87.5% vs 55.2%, p=0.003) and had higher prevalence of dyslipidemia (83.3% vs 61.9%, p=0.046) and peripheral arterial disease (12.5% vs 1.9%, p=0.015). Age at treatment initiation was comparable between groups (67.1 ± 7.9 vs 66.2 ± 13 years, p=0.648). Baseline left ventricular ejection fraction was higher in patients with hematologic malignancies (59.3% vs 54.7%, p=0.02), while metastatic disease was more common among patients with solid tumors (20.8% vs 46.7%, p=0.021).

Overall cardiotoxicity occurred in 20.8% of patients with hematologic malignancies and 35.2% of those with solid tumors (p=0.174). Cardiotoxicity phenotypes differed significantly: arrhythmic cardiotoxicity was more common in hematologic malignancies (20.8% vs 4.8%, p=0.02), while cardiac dysfunction predominated in solid tumors (4.2% vs 21.9%, p=0.045). During follow-up, 57 deaths occurred. Despite lower overall mortality, patients with hematologic malignancies had higher cardiovascular hospitalization rates (41.7% vs 16.2%, p=0.006), remaining significant after multivariable adjustment. Metastatic disease was the only independent predictor of all-cause mortality (OR 5.64, p<0.001). MACE–free survival was similar between malignancy types, although patients with hematologic malignancies showed numerically longer event-free survival (Figure 1).

Conclusions

Hematologic and solid malignancies are associated with distinct cardiovascular profiles, cardiotoxicity phenotypes and clinical outcomes. While hematologic malignancies show higher rates of arrhythmic cardiotoxicity and cardiovascular hospitalization, overall prognosis is primarily driven by oncologic burden, particularly metastatic disease, supporting malignancy-specific cardiovascular surveillance strategies in cardio-oncology practice.