Clinical application of the HFA/ICOS score in breast cancer women: its added value in the prediction of chemotherapy-related cardiac dysfunction

Abstract Background Breast cancer is the most common malignancy in women. It is known that anti-cancer drugs can cause cardiovascular complications. Chemotherapy-related cardiac dysfunction (CTRCD) is the main complication of a treatment with anthracyclines, used to treat breast cancer. Echocardiography is fundamental in the evaluation of the left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) to define CTRCD as mild, moderate or severe, in accordance with 2022 ESC Guidelines on Cardio-Oncology. These guidelines recommend cardiovascular baseline risk stratification using the HFA/ICOS score, in order to plan the most appropriate surveillance program and implement cardioprotective strategies. Purpose to assess the usefulness of HFA/ICOS score in patients with breast cancer undergoing treatment with anthracyclines, in predicting the development of CTRCD. Methods A retrospective study was carried out enrolling 109 patients with breast cancer treated with anthracyclines. We performed a cardiological visit with an ECG and echocardiogram at baseline (T0), three months (T1), and six months (T2) after starting treatment. Baseline cardiovascular risk was assessed in all patients, using HFA/ICOS score and patients were classified into 4 groups: low-risk patients, medium-risk patients, high and very high risk patients. During the follow-up, we assessed the development of CTRCD analyzing changes in LVEF and in GLS. Results At baseline, 61 patients had low risk of developing cardiotoxicity, 34 patients had medium risk, 14 patients had high risk, no patients had very high risk. Analyzing the development of CTRCD, 21 patients (20,5%) developed asymptomatic mild CTRCD at T1 and 13 patients (14%) at T2. 1 patient developed moderate asymptomatic CTRCD at T1 and 1 patient at T2. No patient developed severe CTRCD. We found a significantly higher proportion of CTRCD in the high-risk group (57%, pvalue 0,03) than in the medium (41%) and low risk group (32%). In a subanalysis we found a correlation between the development of asymptomatic CTRCD and the presence of LVEF between 50-54% or arterial hypertension in intermedium/low risk patients. Conclusion our study confirms the usefulness of the HFA/ICOS score in the prediction of CTRCD in high risk breast cancer women; however the evidence of a correlation between the presence of LVEF 50-54% or arterial hypertension and the development of asymptomatic CTRCD emphasises the importance of cardiovascular monitoring also in intermediate risk patients, in which chemotherapy plays an additional role of developing CRTD.