The First Clinical School of Guangzhou University of Chinese Medicine, Guangzhou, China.
Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
BMC Med. 2024 Nov 19;22(1):544. doi: 10.1186/s12916-024-03773-6.
Cancer survivors face elevated risks of heart failure (HF) and death, with cardiac dysfunction being a significant concern. Current evaluations often emphasize systolic function while insufficiently addressing diastolic function. This study aims to investigate the prevalence of diastolic dysfunction and assess its prognostic implications in long-term cancer survivors.
We analyzed participants from the Atherosclerosis Risk in Communities (ARIC) Study with complete echocardiographic assessments and documented cancer histories. Diastolic function was classified by guideline criteria: normal (≤ 1 abnormal parameter), indeterminate (2 abnormal parameters), and dysfunction (≥ 3 abnormal parameters). The primary outcomes were incident HF and all-cause death. Diastolic dysfunction prevalence was compared between cancer survivors and non-cancer participants after propensity score matching. Cox regression, Kaplan-Meier, and restricted cubic spline (RCS) analyses were used to assess associated risks.
A total of 5322 participants were included, with 18.4% (N = 979) being cancer survivors. The mean age of cancer survivors at echocardiography was 76.3 (5.10) years, with a median of 12.17 years since diagnosis. There were no significant differences in diastolic dysfunction prevalence (12.26% vs 10.73%, P = 0.29) after matching. Cox regression revealed a graded association between diastolic dysfunction and risks of HF and death. Fully adjusted hazard ratios were 2.59 (95% CI: 1.59-4.20, P < 0.001) for indeterminate diastolic function and 4.41 (95% CI: 2.40-8.12, P < 0.001) for diastolic dysfunction in HF; and 1.68 (95% CI: 1.26-2.25, P < 0.001) for indeterminate and 2.21 (95% CI: 1.51-3.22, P < 0.001) for diastolic dysfunction in all-cause death. These results were consistent across subgroup and sensitivity analyses and supported by Kaplan-Meier curves. RCS analyses demonstrated dose-response relationships between individual diastolic parameters and outcomes.
Diastolic dysfunction is prevalent among long-term cancer survivors and is stepwise associated with adverse outcomes. These findings underscore the essential need for ongoing monitoring of diastolic function in this population.
癌症幸存者面临心力衰竭（HF）和死亡风险增加，心脏功能障碍是一个重要问题。目前的评估通常强调收缩功能，而对舒张功能的关注不足。本研究旨在调查舒张功能障碍的患病率，并评估其对长期癌症幸存者的预后意义。
我们分析了 Atherosclerosis Risk in Communities（ARIC）研究中接受完整超声心动图评估并记录有癌症病史的参与者。舒张功能障碍按指南标准分类：正常（≤1 个异常参数）、不确定（2 个异常参数）和功能障碍（≥3 个异常参数）。主要结局是新发 HF 和全因死亡。在倾向评分匹配后，比较癌症幸存者和非癌症参与者之间舒张功能障碍的患病率。使用 Cox 回归、Kaplan-Meier 和限制性立方样条（RCS）分析评估相关风险。
共纳入 5322 名参与者，其中 18.4%（N=979）为癌症幸存者。癌症幸存者在进行超声心动图检查时的平均年龄为 76.3（5.10）岁，中位诊断后时间为 12.17 年。匹配后，舒张功能障碍的患病率无显著差异（12.26%比 10.73%，P=0.29）。Cox 回归显示，舒张功能障碍与 HF 和死亡风险之间呈梯度关联。完全调整后的危险比为不确定舒张功能障碍 2.59（95%CI：1.59-4.20，P<0.001），HF 中舒张功能障碍 4.41（95%CI：2.40-8.12，P<0.001）；不确定舒张功能障碍 1.68（95%CI：1.26-2.25，P<0.001），全因死亡中舒张功能障碍 2.21（95%CI：1.51-3.22，P<0.001）。这些结果在亚组和敏感性分析中一致，并得到 Kaplan-Meier 曲线的支持。RCS 分析显示，个体舒张参数与结局之间存在剂量反应关系。
舒张功能障碍在长期癌症幸存者中很常见，且与不良结局呈逐步相关。这些发现强调了在该人群中持续监测舒张功能的必要性。
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