Cardiotoxicity Monitoring and Cancer Therapy-Related Cardiac Dysfunction in a Heterogeneous Cancer Population: A Retrospective Study

Background Cardiotoxicity from chemotherapy can lead to significant heart damage, often without overt symptoms, mainly manifesting as cancer therapy-related cardiac dysfunction (CTRCD) when left ventricular ejection fraction (LVEF) declines by over 10% to below 53%. Current guidelines recommend thorough cardiovascular risk assessments for cancer patients, incorporating personal medical histories and potential biomarkers, yet a standardized risk stratification approach is lacking. This study aims to evaluate chemotherapeutics' effects on LVEF and the influence of patient characteristics on the risk of developing CTRCD. Methods This study is a retrospective chart review at a single center from 2013 to 2023, to assess the CTRCD prevalence in patients referred for transthoracic echocardiography due to cardiotoxicity risk. Data on demographics, comorbidities, medications, and echocardiographic parameters were extracted while maintaining confidentiality. Statistical analysis involved descriptive statistics for 532 patients, paired t-tests and risk-odds ratios for pre- and post-chemotherapy LVEF changes, and left ventricular global longitudinal strain (LVGLS) examination. Results The cohort included 532 patients with a median age of 69 (IQR = 61-78) years, who were predominantly female (57.9%), and had common comorbidities such as hypertension and diabetes. Among those assessed, the median LVEF decreased from 59.5% to 58%, with 9.2% meeting CTRCD criteria, particularly in breast and lung cancer patients. Lung disease and previous transient ischemic attacks (TIA) were associated with greater LVEF declines of 2.5% and 3.5%, respectively, whereas no subclinical cardiotoxicity was found in the limited LVGLS measurements. Conclusion In conclusion, this single-center cohort study highlights a clinical gap in comprehensive echocardiographic surveillance for patients undergoing chemotherapy, with less than half receiving necessary pre- and post-treatment assessments. Despite the moderate incidence of CTRCD (9.2%) in this cohort, reliance solely on LVEF as a marker for cardiotoxicity may overlook significant cardiovascular damage, underscoring the importance of early detection methods. The study revealed that pre-existing lung conditions and a history of TIA impacted LVEF changes, suggesting that these comorbidities should be considered in risk assessments. Overall, the findings advocate for improved cardiac monitoring and intervention strategies to protect the cardiovascular health of cancer patients throughout treatment.