Radiation-induced Cardiomyopathy: Gender Differences In Trends And Outcomes

Introduction Marked evolution of therapies to treat malignancies have led to increased survival of patients affected by cancer, but at the cost of treatment related toxicities. While the data is abundant on chemotherapy-induced cardiotoxicity, less is known about the radiation-induced cardiotoxicity and the role of gender. The aim of our study is to explore gender differences among patients with radiation-induced cardiomyopathy (RICM). Methods We performed a retrospective analysis of the Nationwide Inpatient Sample database from 2011 to 2019. Patients hospitalized for acute heart failure exacerbation with an etiology of RICM were selected. Patients were stratified according to gender. Primary endpoint was in-hospital mortality. Secondary outcomes included incidence of cardiogenic shock (CS), need for renal replacement therapy (RRT), and advanced therapies left ventricular assist device (LVAD) and heart transplant (HTX). Multivariate analysis model was used to adjust for statistically significant differences in baseline characteristics. Results A total of 96,903 patients were identified, 45.9% of which were females. Females were less likely to suffer from atrial fibrillation (38.4% vs 46.0%, p < 0.001), hypertension (38.6% vs 42.2%), and diabetes (34.3% vs 36.5%, p < 0.001). The incidence of pulmonary hypertension was higher among females (16.8% vs 12.6%, p < 0.001). Female gender was associated with better in-hospital mortality (4.3% vs. 5.0%, OR 0.801, p < 0.001). There was no difference in the incidence of cardiogenic shock (1.6% vs 1.6%, p 0.718). There was no significant difference in implementation of advanced therapies: LVAD (n/%= 24/0.1% vs 25/0.0%, p = 0.666) and HTX (n = 25/0.1% vs 15/0.0%, p = 0.35). Conclusions Female gender is associated with better in-hospital outcomes, yet both genders appear to have limited access to advanced therapies. Future Studies are merited to better clarify the role of gender and access to advanced therapies in radiation-induced cardiomyopathy. Marked evolution of therapies to treat malignancies have led to increased survival of patients affected by cancer, but at the cost of treatment related toxicities. While the data is abundant on chemotherapy-induced cardiotoxicity, less is known about the radiation-induced cardiotoxicity and the role of gender. The aim of our study is to explore gender differences among patients with radiation-induced cardiomyopathy (RICM). We performed a retrospective analysis of the Nationwide Inpatient Sample database from 2011 to 2019. Patients hospitalized for acute heart failure exacerbation with an etiology of RICM were selected. Patients were stratified according to gender. Primary endpoint was in-hospital mortality. Secondary outcomes included incidence of cardiogenic shock (CS), need for renal replacement therapy (RRT), and advanced therapies left ventricular assist device (LVAD) and heart transplant (HTX). Multivariate analysis model was used to adjust for statistically significant differences in baseline characteristics. A total of 96,903 patients were identified, 45.9% of which were females. Females were less likely to suffer from atrial fibrillation (38.4% vs 46.0%, p < 0.001), hypertension (38.6% vs 42.2%), and diabetes (34.3% vs 36.5%, p < 0.001). The incidence of pulmonary hypertension was higher among females (16.8% vs 12.6%, p < 0.001). Female gender was associated with better in-hospital mortality (4.3% vs. 5.0%, OR 0.801, p < 0.001). There was no difference in the incidence of cardiogenic shock (1.6% vs 1.6%, p 0.718). There was no significant difference in implementation of advanced therapies: LVAD (n/%= 24/0.1% vs 25/0.0%, p = 0.666) and HTX (n = 25/0.1% vs 15/0.0%, p = 0.35). Female gender is associated with better in-hospital outcomes, yet both genders appear to have limited access to advanced therapies. Future Studies are merited to better clarify the role of gender and access to advanced therapies in radiation-induced cardiomyopathy.