Ibtida Ishmam, Ma Xiaoyue, Al-Sadawi Mohammed, Kosmidou Ioanna, Herrmann Joerg, Liu Jennifer E, Okin Peter M, Yu Anthony F
Department of Medicine, Cardiology Service Memorial Sloan Kettering Cancer Center New York New York USA.
Division of Biostatistics and Epidemiology, Department of Health Care Policy and Research Weill Cornell Medicine New York New York USA.
J Am Heart Assoc. 2025 May 20;14(10):e039203. doi: 10.1161/JAHA.124.039203. Epub 2025 Apr 16.
Strategies to estimate risk of cancer therapy-related cardiac dysfunction (CTRCD) before initiating cardiotoxic cancer treatment are needed. We hypothesized that baseline ECG markers could identify patients at risk for CTRCD.
In this retrospective cohort study, 1278 female patients with stage I-III HER2 (human epidermal growth factor receptor 2)-positive breast cancer meeting the following inclusion criteria were included: baseline ECG with QRS <120 milliseconds, baseline echocardiogram, and ≥1 follow-up echocardiogram. Quantitative measurements of ECG waveform parameters were performed using MUSE (GE Healthcare). The primary outcome of interest was CTRCD at 1 year, defined by left ventricular ejection fraction decline (≥10% to <53% or ≥16% from baseline), or clinical heart failure (New York Heart Association class III/IV). Mean age was 51.7±11.1 years, 990 (77%) received anthracyclines, and all received HER2-targeted therapy. CTRCD occurred in 160 (13%) patients. In a multivariable Cox proportional hazards model adjusting for our previously published CTRCD risk score (composed of patient and treatment-specific factors), 4 ECG markers remained independently associated with CTRCD risk: QRS axis, R-wave duration (lead II), ST segment deviation (lead II), and Sokolow-Lyon voltage (all <0.05). Compared with a model using only clinical CTRCD risk variables, addition of ECG parameters provided incremental value for predicting CTRCD risk (<0.001, likelihood ratio test) with continuous net reclassification improvement of 34.9% and integrated discrimination improvement of 3.4%.
Baseline ECG variables are predictive of subsequent CTRCD and provide incremental value to established clinical risk factors for CTRCD risk classification.
在开始具有心脏毒性的癌症治疗之前，需要有策略来评估癌症治疗相关心脏功能障碍（CTRCD）的风险。我们假设基线心电图标志物可以识别出有CTRCD风险的患者。
在这项回顾性队列研究中，纳入了1278例符合以下纳入标准的I-III期HER2（人表皮生长因子受体2）阳性乳腺癌女性患者：基线心电图QRS<120毫秒、基线超声心动图以及≥1次随访超声心动图。使用MUSE（通用电气医疗集团）对心电图波形参数进行定量测量。感兴趣的主要结局是1年时的CTRCD，定义为左心室射血分数下降（≥10%至<53%或较基线下降≥16%）或临床心力衰竭（纽约心脏协会III/IV级）。平均年龄为51.7±11.1岁，990例（77%）接受了蒽环类药物治疗，所有患者均接受了HER2靶向治疗。160例（13%）患者发生了CTRCD。在一个多变量Cox比例风险模型中，对我们之前发表的CTRCD风险评分（由患者和治疗相关因素组成）进行调整后，4个心电图标志物仍与CTRCD风险独立相关：QRS轴、R波时限（II导联）、ST段偏移（II导联）和索科洛夫-里昂电压（均P<0.05）。与仅使用临床CTRCD风险变量的模型相比，加入心电图参数可为预测CTRCD风险提供增量价值（P<0.001，似然比检验），连续净重新分类改善率为34.9%，综合辨别改善率为3.4%。
基线心电图变量可预测后续CTRCD，并为已有的CTRCD风险分类临床危险因素提供增量价值。
