Monitoring high-risk patients for chemotherapy-related cardiotoxicity: A retrospective analysis

Cancer incidence remains a global challenge. The World Health Organization reported 19976499 new cases in 2022, including 1551060 in Latin America and the Caribbean. While chemotherapy advances have improved survival, these treatments carry significant risks, particularly cardiovascular complications impacting morbidity and mortality. Early cardiotoxicity detection enables targeted interventions, guiding clinical decisions on treatment adjustments to mitigate damage and preserve function. Cardiac imaging and biomarkers assess cardiotoxicity before, during, and after therapy. Despite their importance, the lack of a structured multidisciplinary program hinders early detection and management in high-risk patients.

To evaluate the use of diagnostic tools for monitoring cardiotoxicity in cancer patients receiving high-risk chemotherapy at the National University Hospital of Colombia.

This observational, retrospective cohort study included patients aged ≥ 18 with cancer treated with potentially cardiotoxic chemotherapy at the National University Hospital of Colombia (2016-2019). Data from medical records included demographics, comorbidities, biomarkers, and echocardiographic parameters. Cardiotoxicity was defined by reduced left ventricular ejection fraction (LVEF) using Simpson's method and biomarker abnormalities. Statistical analysis included descriptive methods to compare pre- and post-chemotherapy use of biomarkers and echocardiographic parameters.

From a total of 195 patients analyzed, 8.7% (n = 17) developed cardiotoxicity, predominantly mild (58.8%, n = 10). Affected patients were mostly male (64.7%, n = 11) with a mean age of 51.88 ± 15.9 years. The median LVEF declined from 62% [interquartile range (IQR): 58%-66%] at baseline to 46% (IQR: 34%-56%) post-treatment. STRAIN longitudinal values also significantly decreased, from -18.38 ± 4.62% at baseline to -14.22 ± 4.93% post-treatment. Troponin was measured in 58.8% (n = 10) of cardiotoxicity cases, while ProBNP was less frequently used (17.6%, n = 3).

This study highlights the utility of echocardiography and biomarkers in assessing cardiotoxicity in oncology patients, emphasizing the need for standardized protocols to optimize early diagnosis and management. However, the retrospective nature of the study and the insufficient use of biomarkers may limit the generalizability of the findings.