The predictive value of inotropic reserve in risk stratification of cancer patients with antineoplastic therapy-induced cardiotoxicity

Abstract Background/Introduction The occurrence of cardiotoxicity compromises the prognosis of the oncological patients and blunts the optimal outcome of the antineoplastic treatment. Therefore, when occurring, it is a challenge to evaluate predictive risk stratification markers for morbidity, mortality and cardiotoxicity recovery. Purpose To assess the inotropic reserve of the Left Ventricle for improving the prognosis of patients with established cardiotoxicity. Methods Women with breast cancer and documented chemotherapy-induced cardiotoxicity according to ESC guidelines (LVEF 38±12%) were studied. All patients were treated with the guidelines -based heart failure treatment. Follow-up of patients recording cardiovascular mortality and hospitalizations was performed for two years. Results One hundred and three patients (age 50±14 years) with cardiovascular events demonstrated a blunted response to dobutamine administration (ΔCO 29±22% vs 46±31%, p < 0.0001). A ΔCO <25% was considered as the cut-off for the inotropic reserve threshold .The cut-off of ΔWMSI for cardiovascular events was considered to be 0.35 with a specificity of 86% and sensitivity of 72% . In multivariate analysis, inotropic reserve HR 7.22 (95% CI 2.3-17.6; p=0.001) and NYHA functional stage HR 8.4 (95% CI 2.7-24.3; p=0.001) were independent predictors of cardiovascular death. At 1.1±0.8 years LVEF improved in 58 % of patients demonstrating the presence of inotropic reserve with ΔWMSI 0.62 predicting resuscitated EF with a specificity of 77% and sensitivity of 73%. Finally, 3 cardiovascular deaths and 22 hospitalizations for heart failure were recorded after 1.4±1.2 years. Conclusion The presence of inotropic reserve contributes to the estimation of the burden of oncological-therapy induced cardiotoxicity and predicts reversibility of cardiac dysfunction in cardio-oncology patients.