Marilyn L Kwan1, Richard K Cheng2,3, Carlos Iribarren4, Hanjie Shen5, Cecile A Laurent4, Janise M Roh4, Dawn L Hershman6, Lawrence H Kushi4, Heather Greenlee2,3,5, Jamal S Rana4,7. 1. Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA. Marilyn.L.Kwan@kp.org. 2. University of Washington School of Medicine, Seattle, WA, USA. 3. Seattle Cancer Care Alliance, Seattle, WA, USA. 4. Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA. 5. Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. 6. Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA. 7. Department of Cardiology, Oakland Medical Center, Kaiser Permanente Northern California, Oakland, CA, USA.
Abstract
PURPOSE: While clinical heart failure (HF) is recognized as an adverse effect from breast cancer (BC) treatment, sparse data exist on specific HF phenotypes in affected BC survivors. We examined risk of HF by left ventricular ejection fraction (LVEF) status in women with a history of BC. METHODS: 14,804 women diagnosed with all stages of invasive BC from 2005 to 2013 and with no history of HF were matched 1:5 to 74,034 women without BC on birth year, race, and ethnicity. LVEF values were extracted from echocardiography studies within 30 days before through 90 days after the HF clinical encounter. HF was stratified into HF with preserved ejection fraction (HFpEF, LVEF ≥ 45%) and HF with reduced ejection fraction (HFrEF, LVEF < 45%). Cumulative incidence rates (CIRs) were estimated with competing risk of overall death. Hazard ratios (HR) were calculated by multivariable Cox proportional hazards regression. RESULTS: Mean time to HF diagnosis was 5.31 years (range 0.03-13.03) in cases and 5.25 years (range 0.01-12.94) in controls. 10-year CIRs were 1.2% and 0.9% for overall HF, 0.8% and 0.7% for HFpEF, and 0.4% and 0.2% for HFrEF in cases and controls, respectively. In fully adjusted models, an overall significant increased risk of HF in cases versus controls was observed (HR: 1.31, 95% CI 1.14, 1.51). The increased risk was seen for both HFrEF (HR: 1.59, 95% CI 1.22, 2.08) and HFpEF (HR: 1.22; 95% CI 1.03, 1.45). CONCLUSION: BC survivors experienced higher risk of HF compared with women without BC, and the risk persisted across LVEF phenotypes. Systematic cardio-oncology surveillance should be considered to mitigate this risk in BC patients.
PURPOSE: While clinical heart failure (HF) is recognized as an adverse effect from breast cancer (BC) treatment, sparse data exist on specific HF phenotypes in affected BC survivors. We examined risk of HF by left ventricular ejection fraction (LVEF) status in women with a history of BC. METHODS: 14,804 women diagnosed with all stages of invasive BC from 2005 to 2013 and with no history of HF were matched 1:5 to 74,034 women without BC on birth year, race, and ethnicity. LVEF values were extracted from echocardiography studies within 30 days before through 90 days after the HF clinical encounter. HF was stratified into HF with preserved ejection fraction (HFpEF, LVEF ≥ 45%) and HF with reduced ejection fraction (HFrEF, LVEF < 45%). Cumulative incidence rates (CIRs) were estimated with competing risk of overall death. Hazard ratios (HR) were calculated by multivariable Cox proportional hazards regression. RESULTS: Mean time to HF diagnosis was 5.31 years (range 0.03-13.03) in cases and 5.25 years (range 0.01-12.94) in controls. 10-year CIRs were 1.2% and 0.9% for overall HF, 0.8% and 0.7% for HFpEF, and 0.4% and 0.2% for HFrEF in cases and controls, respectively. In fully adjusted models, an overall significant increased risk of HF in cases versus controls was observed (HR: 1.31, 95% CI 1.14, 1.51). The increased risk was seen for both HFrEF (HR: 1.59, 95% CI 1.22, 2.08) and HFpEF (HR: 1.22; 95% CI 1.03, 1.45). CONCLUSION: BC survivors experienced higher risk of HF compared with women without BC, and the risk persisted across LVEF phenotypes. Systematic cardio-oncology surveillance should be considered to mitigate this risk in BC patients.
Authors: Anuradha Lala; Upasana Tayal; Carine E Hamo; Quentin Youmans; Sana M Al-Khatib; Biykem Bozkurt; Melinda B Davis; James Januzzi; Robert Mentz; Andrew Sauer; Mary Norine Walsh; Clyde Yancy; Martha Gulati Journal: J Card Fail Date: 2021-11-10 Impact factor: 5.712
Authors: Rudolf A de Boer; Joseph Pierre Aboumsallem; Valentina Bracun; Douglas Leedy; Richard Cheng; Sahishnu Patel; David Rayan; Svetlana Zaharova; Jennifer Rymer; Jennifer M Kwan; Joshua Levenson; Claudio Ronco; Paaladinesh Thavendiranathan; Sherry-Ann Brown Journal: Cardiooncology Date: 2021-06-21