Independent and incremental value of ECG markers for prediction of cancer therapy-related cardiac dysfunction Journal Article
| Authors: | Ibtida, I.; Ma, X.; Al-Sadawi, M.; Kosmidou, I.; Herrmann, J.; Liu, J. E.; Okin, P. M.; Yu, A. F. |
| Article Title: | Independent and incremental value of ECG markers for prediction of cancer therapy-related cardiac dysfunction |
| Abstract: | BACKGROUND: Strategies to estimate risk of cancer therapy-related cardiac dysfunction (CTRCD) before initiating cardiotoxic cancer treatment are needed. We hypothesized that baseline ECG markers could identify patients at risk for CTRCD. METHODS AND RESULTS: In this retrospective cohort study, 1278 female patients with stage I-III HER2 (human epidermal growth factor receptor 2)-positive breast cancer meeting the following inclusion criteria were included: baseline ECG with QRS <120 milliseconds, baseline echocardiogram, and ≥1 follow-up echocardiogram. Quantitative measurements of ECG waveform parameters were performed using MUSE (GE Healthcare). The primary outcome of interest was CTRCD at 1 year, defined by left ventricular ejection fraction decline (≥10% to <53% or ≥16% from baseline), or clinical heart failure (New York Heart Association class III/IV). Mean age was 51.7±11.1 years, 990 (77%) received anthracyclines, and all received HER2-targeted therapy. CTRCD occurred in 160 (13%) patients. In a multivariable Cox proportional hazards model adjusting for our previously published CTRCD risk score (composed of patient and treatment-specific factors), 4 ECG markers remained independently associated with CTRCD risk: QRS axis, R-wave duration (lead II), ST segment deviation (lead II), and Sokolow-Lyon voltage (all P<0.05). Compared with a model using only clinical CTRCD risk variables, addition of ECG parameters provided incremental value for predicting CTRCD risk (P<0.001, likelihood ratio test) with continuous net reclassification improvement of 34.9% and integrated discrimination improvement of 3.4%. CONCLUSIONS: Baseline ECG variables are predictive of subsequent CTRCD and provide incremental value to established clinical risk factors for CTRCD risk classification. |
| Keywords: | adult; aged; middle aged; retrospective studies; antineoplastic agents; antineoplastic agent; epidermal growth factor receptor 2; risk factors; drug effect; breast neoplasms; retrospective study; risk factor; risk assessment; cardiotoxicity; breast tumor; predictive value of tests; receptor, erbb-2; drug therapy; anthracycline; anthracyclines; electrocardiography; heart stroke volume; stroke volume; predictive value; ventricular function, left; heart left ventricle function; humans; human; female; ecg; cardio‐oncology |
| Journal Title: | Journal of the American Heart Association |
| Volume: | 14 |
| Issue: | 10 |
| ISSN: | 2047-9980 |
| Publisher: | Wiley Blackwell |
| Date Published: | 2025-05-20 |
| Start Page: | e039203 |
| Language: | English |
| DOI: | 10.1161/jaha.124.039203 |
| PUBMED: | 40240957 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledge in the PDF -- Corresponding authors is MSK author: Anthony F. Yu -- Source: Scopus |
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