Hidden vascular vulnerability in chemotherapy-naive patients with hemoblastosis: a window of opportunity for early cardioprotection
R B Alieva, K H G Fozilov, Y U N Belenkov, I S Ilgisonis, N V Khabarova, D A KutsatkinaAbstract
Background
Cardiovascular toxicity (CVT) of anticancer therapy remains a major determinant of long-term outcomes in oncology patients. Current baseline risk assessment tools, including HFA-ICOS (ESC) scales, rely predominantly on clinical characteristics, medical history, standard laboratory and instrumental evaluation of myocardium involvement, while direct markers of vascular dysfunction are not incorporated into routine stratification algorithms. This may lead to underestimation of baseline vascular vulnerability and missed opportunities for early preventive intervention.
Purpose
To evaluate structural and functional vascular wall parameters in patients with newly diagnosed hemoblastosis prior to chemotherapy and to explore their potential in supporting earlier initiation of cardioprotective strategies.
Methods
This prospective observational study included 50 chemotherapy-naive patients with newly diagnosed hemoblastosis. All patients underwent carotid ultrasound examination (ESAOTE MyLab 70, Italy) with assessment of carotid intima–media thickness (IMT) and carotid–femoral pulse wave velocity (cf-PWV). Baseline CVT-risk was stratified according to HFA-ICOS (ESC) criteria.
Results
The mean age of the cohort was 58.3 ± 17.3 years (95% CI 53.4–63.2), with a female predominance (56%). According to HFA-ICOS (ESC) baseline risk stratification, 24% of patients were classified as low risk, 46% - as moderate risk, and 30% - as high or very high CVT-risk. Low-risk patients showed no evidence of vascular dysfunction, with a median IMT of 0.78 mm [0.75–0.80] and a median cf-PWV of 9.0 m/s [8.0–9.0]. In contrast, patients classified as moderate and high/very high risk demonstrated comparable and pronounced morpho-functional vascular alterations. Moreover, no statistically significant differences were observed between these two groups: median IMT 0.95 mm [0.90–1.00] vs 1.00 mm [0.90–1.25] (p = 0.07) and median cf-PWV 11.0 m/s [10.0–12.0] vs 11.5 m/s [10.5–13.5] (p = 0.15), respectively.
Conclusions
Patients with newly diagnosed hemoblastosis demonstrate subclinical vascular impairment prior to the initiation of chemotherapy, reflecting an underlying cardiovascular vulnerability. The absence of significant differences in objective vascular parameters between moderate and high/very high HFA-ICOS risk categories suggests a potential underestimation of CVT- risk in patients classified as intermediate risk. These findings indicate that the pre-chemotherapy period may represent a critical window of opportunity for the early initiation of cardioprotective strategies, aimed at mitigating subsequent CVT, including long-term period. Validation in larger prospective cohorts is warranted.