Validation of a scale for evaluating the cardiovascular risk after breast cancer therapy: the clinical scale for breast cancer treatment related cardiovascular toxicity

doi:10.19401/j.cnki.1007-3639.2022.01.007

Abstract

Abstract:

Background and purpose: The treatment-related cardiovascular disease in patients with breast cancer poses a greater mortality threat than cancer itself. To assist clinical oncologist, we introduced a scale to help clinicians by screening out patients with breast cancer who were at risk of cardiovascular diseases. The breast cancer patients in Zhongshan Hospital, Fudan University were analyzed retrospectively by the scale. Methods: This was a single center, retrospective trial. A total of 760 patients who met the inclusion and exclusion criteria were enrolled in this trial from January 1, 2017 to December 31, 2018. The incidence rate of cardiovascular risk was collected from patients eligible for admission. Secondly, follow-up information for each patient was evaluated by the scale and the clinician. The repeatability, sensitivity, specificity and consistency of the scale were evaluated. Results: The average follow-up duration was (746.55±309.94) d, and the average population age was (56.60±12.62) years. A total of 36 patients developed severe arrhythmias during or after the treatment, 8 patients with emerging myocardial injury and 6 patients with emerging cardiac insufficiency. The follow-up rates of patients with test for NT-proBNP from half a year to one year and more than one year after baseline were 34.31% and 29.62%, while 35.48% and 32.48% for those who took echocardiography. The sensitivity, specificity and overall accuracy of medium-and high-risk patient tests were 0.828, 0.934 and 0.921, respectively. The sensitivity, specificity and overall accuracy of high-risk patient tests were 0.983, 0.986, and 0.986, respectively. The linear consistency with clinical judgment was κ=0.633, P<0.05. The average time for completion of the scale was (108.67±44.86) s. Conclusion: The incidence rate of cardiovascular disease in breast cancer patients is even higher than that of cancer itself. Therefore, it is essential to monitor cardiovascular disease. In this trial, we provide a simple and feasible scale, which has high accuracy, specificity and convenience. We hope to promote it as soon as possible.

Key words: Breast cancer, Treatment-related cardiovascular diseases, Scale

CLC Number:

R737.9

ZHANG Chi, CHEN Jiahui, LIN Jinyi, WANG Yan, ZHANG Sijia, ZHU Wei, CHENG Leilei. Validation of a scale for evaluating the cardiovascular risk after breast cancer therapy: the clinical scale for breast cancer treatment related cardiovascular toxicity[J]. China Oncology, 2022, 32(1): 54-60.

Figures/Tables 3

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References 17

[1]	JEMAL A, SIEGEL R, WARD E, et al. Cancer statistics, 2009[J]. CA A Cancer J Clin, 2009, 59(4): 225-249. doi: 10.3322/caac.20006
[2]	SIEGEL R L, MILLER K D, JEMAL A. Cancer statistics, 2018[J]. CA Cancer J Clin, 2018, 68(1): 7-30. doi: 10.3322/caac.21442
[3]	BRAY F, FERLAY J, SOERJOMATARAM I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6): 394-424. doi: 10.3322/caac.v68.6
[4]	PIEPOLI M F, HOES A W, AGEWALL S, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: the sixth joint task force of the European Society of Cardiology and Other Societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR)[J]. Eur Heart J, 2016, 37(29): 2315-2381. doi: 10.1093/eurheartj/ehw106
[5]	HEIDENREICH P A, KAPOOR J R. Radiation induced heart disease: systemic disorders in heart disease[J]. Heart, 2009, 95(3): 252-258. doi: 10.1136/hrt.2008.149088
[6]	RUTQVIST L E, ROSE C, CAVALLIN-STÅHL E. A systematic overview of radiation therapy effects in breast cancer[J]. Acta Oncol, 2003, 42(5/6): 532-545. doi: 10.1080/02841860310014444
[7]	HEINZERLING L, OTT P A, HODI F S, et al. Cardiotoxicity associated with CTLA4 and PD1 blocking immunotherapy[J]. J Immunother Cancer, 2016, 4: 50. doi: 10.1186/s40425-016-0152-y
[8]	HU J R, FLORIDO R, LIPSON E J, et al. Cardiovascular toxicities associated with immune checkpoint inhibitors[J]. Cardiovasc Res, 2019, 115(5): 854-868. doi: 10.1093/cvr/cvz026
[9]	GAGGIN H K, JANUZZI J L JR. Biomarkers and diagnostics in heart failure[J]. Biochim Biophys Acta, 2013, 1832(12): 2442-2450.
[10]	PARK J J, PARK J B, PARK J H, et al. Global longitudinal strain to predict mortality in patients with acute heart failure[J]. J Am Coll Cardiol, 2018, 71(18): 1947-1957. doi: 10.1016/j.jacc.2018.02.064
[11]	ZAMORANO J L, LANCELLOTTI P, RODRIGUEZ MUÑOZ D, et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: the task force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC)[J]. Eur Heart J, 2016, 37(36): 2768-2801. doi: 10.1093/eurheartj/ehw211
[12]	PATNAIK J L, BYERS T, DIGUISEPPI C, et al. Cardiovascular disease competes with breast cancer as the leading cause of death for older females diagnosed with breast cancer: a retrospective cohort study[J]. Breast Cancer Res, 2011, 13(3): R64. doi: 10.1186/bcr2901
[13]	GERNAAT S A M, HO P J, RIJNBERG N, et al. Risk of death from cardiovascular disease following breast cancer: a systematic review[J]. Breast Cancer Res Treat, 2017, 164(3): 537-555. doi: 10.1007/s10549-017-4282-9
[14]	CARDINALE D, COLOMBO A, BACCHIANI G, et al. Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy[J]. Circulation, 2015, 131(22): 1981-1988. doi: 10.1161/CIRCULATIONAHA.114.013777
[15]	VON HOFF D D, LAYARD M W, BASA P, et al. Risk factors for doxorubicin-induced congestive heart failure[J]. Ann Intern Med, 1979, 91(5): 710-717. doi: 10.7326/0003-4819-91-5-710
[16]	FELKER G M, THOMPSON R E, HARE J M, et al. Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy[J]. N Engl J Med, 2000, 342(15): 1077-1084. doi: 10.1056/NEJM200004133421502
[17]	MARTEL S, MAURER C, LAMBERTINI M, et al. Breast cancer treatment-induced cardiotoxicity[J]. Expert Opin Drug Saf, 2017, 16(9): 1021-1038. doi: 10.1080/14740338.2017.1351541

^Item	Description	Score
Age>60 years	-	1
Menopause	-	1
History of endocrine therapy	-	1
History of anthracyclines therapy	-	2
History of paclitaxel therapy	-	1
History of HER2 therapy	-	1
History of PD1/PDL1 therapy	-	1
History of radiotherapy	Radiotherapy for chest (non-left breast)	1
	Radiotherapy for left breast	2
Complication with cardiovascular disease	Moderate coronary stenosis	9
	Severe coronary stenosis	C
	Hypertrophic obstructive cardiomyopathy	C
	Moderate/massive pericardial effusion	C
	Moderate/severe valve stenosis or regurgitation	C
	Severe pulmonary hypertension	C
	Other cardiovascular diseases	2
Emerging chest tightness, chest pain, palpitation, shortness of breath and dyspnea^*		3
Emerging edema or aggravation of edema^*		2
Blood pressure fluctuation	SBP>140 mmHg or<90 mmHg with or without DBP >90 mmHg	2
	Patients with Diabetes: SBP>130 mmHg with or without DBP>80 mmHg	2
Elevation of troponin (cTnI/cTnT)	Baseline elevation	1
	Progressive elevation	C
Elevation of NT-proBNP/BNP	Baseline elevation	1
	Progressive elevation^**	3
Elevation of D dimmer	Baseline elevation	1
	Progressive elevation^**	3
Electrocardiogram	New onset heart rate ≥130 bpm, or ≤45 bpm, or QTc≥500 ms	C
	ST segment elevation	C
	New onset heart rate (>100 bpm but <130 bpm, or <55 bpm but >45 bpm)	1
	ST-T changes	1
	Frequent premature beats	9
	Other abnormality	2
Echocardiography	45%≤LVEF<55%	2
	LVEF<45%	C
	LVEF<55% and LVEF decreased by more than 10% from baseline	C
	Other abnormality	2
Optional	Diastolic function insufficient	1
	Reduction of GLS ≥15%	1
	Abnormal CMR/MUGA results	C
	sST2 elevation	1
	Abnormal of noninvasive cardiac assessment	1

Characteristic	2017	2018	Total
Total	509	511	1 020
Enrolment	394	366	760
Without chemotherapy	101	117	218
Primary tumors in other parts	14	28	42
Use of anthracyclines therapy	184	157	341
Use of anthracyclines and paclitaxel therapy	143	132	275
Use of paclitaxel therapy	236	220	456
Use of endocrine therapy	295	257	552
Endocrine therapy only	92	99	191
Use of HER2 therapy	59	90	149
Use of radiotherapy	96	88	184
Average follow-up t/d x±s	878.08±335.23	604.96±199.58	746.55±309.94
Medium follow-up t/d x±s	992.50	653.00	749.00
Average age/year	56.52±12.68	56.70±12.57	56.60±12.62

Item	Number of patients n	Percentage/%	Mean age of enrollment/year
Emerging myocardial injury	8	1.05%	68.0
Emerging heart insufficient	6	0.79%	69.5
Emerging arrhythmia	36	4.74%	63.1
Total	50	6.58%