Cardio-oncology is a recent rapid-developing multidisciplinary approach created by oncologists in accordance with cardiologists with the objective to minimize the adverse cardiovascular effects of contemporary cancer therapy and to maximize the benefits that can be obtained from it.
Pre-treatment cancer therapy-related cardiovascular toxicity (CTR-CVT) risk assessment can be performed using HFA-ICOS risk assessment tools, in addition to a careful clinical history analysis, physical examination, ECG, biomarkers, and echocardiography.
In our study, the analysis of standard and advanced echocardiographic parameters (left atrial strain or LAS, left ventricular global longitudinal strain or GLS, and 3D echocardiography) were performed at baseline, at three, six, and 12 months timepoints.
A number of 53 female patients with breast cancer, scheduled to receive chemotherapy, was enrolled. All patients had basal 3D LVEF values ≥ 50% and a basal GLS > -18,5%.
Statistically significant reductions (p<0,001) in 3D LVEF at three, six, and 12 months compared to baseline were found, and in all cases 3D LVEF levels were within the reference values (3D LVEF ≥ 50%).
GLS and atrial strain parameters (LASr and LASct) were significantly reduced compared to the baseline at 3 months (GLS p<0.01; LASr p<0,001; LASct p<0,001), 6 months (GLS p<0.05; LASr p<0,001; LASct p<0,001) and 12 months (GLS p<0.01; LASr p<0,05; LASct p<0,01).
Moreover, 10 patients out of 53 (18,87%) had asymptomatic cardiotoxicity (expressed by >15% of GLS reduction compared to baseline) after 12 months, and 17 out of 53 patients (32,08%) had atrial dysfunction (expressed by >15% of LASr reduction compared to baseline) after three months. Although atrial dysfunction was not statistically significant in predicting asymptomatic cardiotoxicity (p=0.12), patients with atrial dysfunction at three months have a 3,7 times greater risk of developing asymptomatic cardiotoxicity at 12 months.
With our analysis, we found that HFA-ICOS risk score could be considered a predictor of cardiotoxicity at 12 months (p<001). Further studies will be conducted, in order to expand the population and to confirm our results.