Prevalence of cardiovascular disease in cancer patients. CARDIOTOX Registry
López Fernández, Teresa1 ; González-Fernandez, Oscar1; Álvarez Ortega, Carlos1 ; Valbuena
López, Silvia1; Rodriguez Fraga, Olaia2; Moreno Yangüela, Mar1; Buño Soto, Antonio2;
Batlle Feliu Jaime3; Canales Albendea Miguel4; López- Sendón, José Luis1.
1Cardiology
Department. 2 Clinical Laboratory Department 3 Oncology Department
Hematology Department. Cardio-Oncology Unit. University Hospital La Paz, IdiPaz
Research Institute, Madrid, Spain
4
Introduction: Cancer treatments present an increased risk of cardiovascular
complications. Different studies correlate abnormal transthoracic echo (TTE) findings, as
well as the presence of cardiovascular risk factors (CVRF) with cardiotoxicity. The purpose
of our study is to analyze the prevalence of baseline abnormal ETT findings and CVRF
before cardiotoxic treatment.
Methods: Patients from CARDIOTOX registry were included. TTE was performed between
August 2011 and April 2015 in these patients before chemotherapy.
Results: 576 patients were included; mean age was 55.26±14.2 years, 83% female. Tumor
location was: 56.3% breast cancer, 26% lymphoma, 17.7% others. 11.6% of the patients
had previous cancer, 5.9% previous chemotherapy and 4.5% radiation therapy. Regarding
CVRF, 21.5% had hypertension, 24.9% dyslipidemia, 7.1% diabetes and 26% current
smoking. 2.2% of patients had a left ventricular ejection fraction (LVEF) <53%. 46.1% of
patients had a Global Longitudinal Strain (GLS) >-19% and 4.6% >-15%. TAPSE<16mm
occurred in 0.8% of patients. Lateral E/E´ ratio was ≥15 in 4.4% of patients. The most
common abnormal finding was left atrial enlargement (LAA=area≥20cm2), present in
23.1% of patients. We found significant differences in left ventricular dysfunction
(LVEF<53%), GLS>-19, E/E´ratio≥15 and LAE according to age, being more prevalent these
findings in patients >60 y.o. Patients presenting previous cancer associate a statistically
significant higher prevalence of LVEF<53% (8.2 vs 1.4; P=0.006), as well as patients with
chemotherapy (8 vs 1.9; P= 0.099), hypertension ( 5.1vs1.4; p=0.028) and diabetes
(7.7vs1.8; p=0.049)(Table 1).
Conclusion: Age, previous cancer and CVRF associate a higher prevalence of abnormal
echo findings. In young patients without previous cancer or CVRF a baseline TTE do not
change clinical decisions and efforts must be concentrated to monitor cardiotoxicity while
treatment.
Mean Values
LVEF (%)
GLS (%)
LAA (cm2)
E/E´
% patients with
LVEF <53%
GLS >-19%
E/E´ ≥15
LAA ≥20cm2
<60 y.o. (n=355)
63.58±5.61
-19.03±2.58
16.05±3.52
6.81±2.39
>60 y.o. (n=221)
63.59±7.08
-18.12±3.03
18.59±4.71
10.29±3.97
p
NS
0.008
<0.001
<0.001
1.2
41
0
15.5
3.7
54.9
10.5
34.9
0.047
0.025
0.028
<0.001