Association between baseline hemodynamic indices, cardiotoxicity risk, and survival in women with breast cancer
JOURNAL OF NUCLEAR CARDIOLOGY(2024)
Abstract
Background: The outcome of breast cancer (BrCa) women monitored by low -dose equilibrium radionuclide angiography (ERNA) remains challenging to predict. Aim: This study aims to determine whether heart rate (HR)/blood pressure (BP) ratiobased indexes, previously confirmed to predict outcomes of various diseases, also predict BrCa-therapy-related cardiotoxicity and survival. Methods: Predictors of cardiotoxicity and survival were determined among pre -therapy variables, including shock index ([SI HR/systolic BP) and age -adjusted SI (ASI), in a female BrCa cohort with normal baseline ERNA-left ventricular ejection fraction (LVEF). Results: We included 274 women with a median age of 54.8 (interquartile range: 45.5-65.4) years, 271 treated with anthracyclines and 96 with trastuzumab. During a median followup of 25.9 (18.6-33.5) months, 31 women developed cardiotoxicity (LVEF: <50% and >10% drop from baseline), and 25 died. Baseline ASI was a multivariate predictor (p < 0.001) of (i) cardiotoxicity, in association with trastuzumab treatment (p = 0.010), and LV end -diastolic volume (p = 0.001) and (ii) survival, in association with metastasis (p < 0.001) and estimated glomerular filtration rate (p = 0.008). Cardiotoxicity poorly impacted survival (p = 0.064). The 36 -month cardiotoxicity and mortality rates were markedly higher for patients in the upper half of baseline ASI values (ASI: >30 years min-1.mmHg(-1), 16.5% and 20.7%, respectively) than in the lower half (7.6% and 4.5%, respectively, both p < 0.05). Conclusions: In BrCa women with normal baseline ERNA-LVEF, HR/BP ratio -based indexes unmask hemodynamic profiles associated with increased cardiotoxicity risk and decreased survival, highlighting the need for a comprehensive assessment of cardiac- and vascular -related risks in BrCa women monitored by ERNA.
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Key words
Equilibrium radionuclide angiography,Breast cancer,Cardiotoxicity,Hemodynamics,Shock index
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