@article{3104457,
    title = "Classification, prevalence, and outcomes of anticancer therapy-induced cardiotoxicity: The CARDIOTOX registry",
    author = "López-Sendón, J. and Álvarez-Ortega, C. and Zamora Auñon, P. and Buño Soto, A. and Lyon, A.R. and Farmakis, D. and Cardinale, D. and Canales Albendea, M. and Feliu Batlle, J. and Rodríguez Rodríguez, I. and Rodríguez Fraga, O. and Albaladejo, A. and Mediavilla, G. and González-Juanatey, J.R. and Martínez Monzonis, A. and Gómez Prieto, P. and González-Costello, J. and Serrano Antolín, J.M. and Cadenas Chamorro, R. and López Fernández, T.",
    journal = "EUROPEAN HEART JOURNAL-CARDIOVASCULAR PHARMACOTHERAPY",
    year = "2020",
    volume = "41",
    number = "18",
    pages = "1720-1729",
    publisher = "Oxford University Press",
    doi = "10.1093/eurheartj/ehaa006",
    keywords = "aldosterone antagonist;  amino terminal pro brain natriuretic peptide;  angiotensin receptor antagonist;  anthracycline;  antineoplastic agent;  beta adrenergic receptor blocking agent;  dipeptidyl carboxypeptidase inhibitor;  hydroxymethylglutaryl coenzyme A reductase inhibitor;  ivabradine;  protein tyrosine kinase inhibitor;  troponin T, adult;  Article;  biochemical analysis;  cancer chemotherapy;  cancer patient;  cancer radiotherapy;  cardiotoxicity;  cardiovascular parameters;  clinical outcome;  controlled study;  disease classification;  disease exacerbation;  disease marker;  disease registry;  disease severity;  dyslipidemia;  echocardiography;  female;  follow up;  hazard ratio;  heart failure;  heart left ventricle ejection fraction;  heart left ventricle failure;  heart left ventricle function;  high risk patient;  human;  major clinical study;  male;  malignant neoplasm;  mediastinum;  medical history;  middle aged;  mortality;  mortality rate;  patient selection;  practice guideline;  prevalence;  priority journal;  prospective study;  radiological parameters;  aged;  epidemiology;  heart left ventricle function;  heart stroke volume;  prevalence;  register, Adult;  Aged;  Female;  Humans;  Male;  Middle Aged;  Prevalence;  Registries;  Stroke Volume;  Ventricular Dysfunction, Left;  Ventricular Function, Left",
    abstract = "Aim: Cardiotoxicity (CTox) is a major side effect of cancer therapies, but uniform diagnostic criteria to guide clinical and research practices are lacking. Methods and results: We prospectively studied 865 patients, aged 54.7 ± 13.9; 16.3% men, scheduled for anticancer therapy related with moderate/high CTox risk. Four groups of progressive myocardial damage/dysfunction were considered according to current guidelines: normal, normal biomarkers (high-sensitivity troponin T and N-Terminal natriuretic pro-peptide), and left ventricular (LV) function; mild, abnormal biomarkers, and/or LV dysfunction (LVD) maintaining an LV ejection fraction (LVEF) ≥50%; moderate, LVD with LVEF 40-49%; and severe, LVD with LVEF ≤40% or symptomatic heart failure. Cardiotoxicity was defined as new or worsening of myocardial damage/ventricular function from baseline during follow-up. Patients were followed for a median of 24 months. Cardiotoxicity was identified in 37.5% patients during follow-up [95% confidence interval (CI) 34.22-40.8%], 31.6% with mild, 2.8% moderate, and 3.1% with severe myocardial damage/dysfunction. The mortality rate in the severe CTox group was 22.9 deaths per 100 patients-year vs. 2.3 deaths per 100 patients-year in the rest of groups, hazard ratio of 10.2 (95% CI 5.5-19.2) (P < 0.001). Conclusions: The majority of patients present objective data of myocardial injury/dysfunction during or after cancer therapy. Nevertheless, severe CTox, with a strong prognostic relationship, was comparatively rare. This should be reflected in protocols for clinical and research practices. © 2020 Published on behalf of the European Society of Cardiology. All rights reserved."
}