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. 2021 Mar 15:33:100751.
doi: 10.1016/j.ijcha.2021.100751. eCollection 2021 Apr.

A novel scoring system to estimate chemotherapy-induced myocardial toxicity: Risk assessment prior to non-anthracycline chemotherapy regimens

Can Öztürk  1 , Dayanat Validyev  1 , Ulrich Marc Becher  1 , Marcel Weber  1 , Georg Nickenig  1 , Vedat Tiyerili  1
Affiliations

A novel scoring system to estimate chemotherapy-induced myocardial toxicity: Risk assessment prior to non-anthracycline chemotherapy regimens

Can Öztürk et al. Int J Cardiol Heart Vasc. .

Abstract

Background: Myocardial toxicity is a common side effect of chemotherapy and is associated with adverse outcomes in cancer patients. Sufficient prediction of chemotherapy-induced myocardiotoxicity (CIMC) is desirable. Therefore, we sought to develop a feasible scoring system to predict CIMC in cancer patients undergoing non-anthracycline chemotherapy.

Methods: We determined a scoring system, the "Cardiotoxicitiy Score" (the CardTox-Score), by multivariable regression of the parameters considered relevant to the development of CIMC, based on previously published data and current guidelines. Variables of the risk model consist of clinical (age, presence of cardiovascular risk conditionsconditions), blood tests (NT-proBNP), and echocardiographic parameters (left ventricular (LV) ejection fraction, LV strain analysis). The CardTox-Score was examined in an internal validation cohort by use of ROC and regression analysis.

Results: We prospectively investigated 225 patients (58.21 ± 6.3 years, 52.8% female) who received non-anthracycline myocardiotoxic anticancer agent as a derivation cohort. All patients underwent echocardiography before, during and after anticancer therapy. The mean follow-up duration was 25 ± 4 months. We found the CardTox-Score (>6 points) to be a strong independent predictor (AUC: 0.983, OR: 6.38, 95% CI: 1.6 2.8, p < 0.001) for the development of CIMC with high sensitivity (100%) and specificity (84.2%) in the validation cohort (n = 30, 59.2 ± 6.5 years, 57% female). Moreover, the CardTox-Score appropriately predicted all-cause mortality with high specificity (93.7%) and sensitivity (92.9%) as well (OR: 4.85, AUC: 0.978, p = 0.01).

Conclusion: The CardTox-Score offers a promising, feasible, and easy-to-handle scoring system for predicting CIMC in cancer patients undergoing non-anthracycline regimes, independent from the type of cancer.

Keywords: AUC, Area under the curve; CI, Confidence interval; CK-MB, Creatine kinase isoenzyme MB; Cardiomyopathy; Cardiotoxicity; Chemotherapy; FU, Follow-up; LDL, Low-density lipoprotein; LV-EF, Left-ventricular ejection fraction; LV-GLS, Left-ventricular global longitudinal strain; NT-proBNP, N terminal pro-brain natriuretic peptide; OR, Odds ratio; ROC, Receiver operating characteristic; Risk assessment; Strain analysis.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Scatter diagram of the positive linear correlation between delta LV-EF (DeltaEF) and delta LV-GLS (DeltaGLS) with a trend line.
Fig. 2
Fig. 2
A: ROC curve of the CardTox-Score for the prediction of the development of CIMC in the validation cohort (AUC: 0.983, sensitivity: 100%, specificity: 84.2%, p < 0.0001). B: ROC curve of the CardTox-Score for the prediction of all-cause mortality in the validation cohort (AUC: 0.978, sensitivity: 92.9%, specificity: 93.7%, p < 0.001).
Fig. 3
Fig. 3
A: Graphical depiction of the relationship between the CardTox-Score and probability of CIMC in the validation cohort (OR: 6.38, p < 0.001). B. Graphical depiction of the relationship between the CardTox-Score and probability of all-cause mortality in the validation cohort (OR: 4.85, p = 0.01).
Supplementary figure 1
Supplementary figure 1
See this image and copyright information in PMC

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