Predictive value of echocardiography in assessment of all-cause death in cardio-oncologic patients: a single-center prospective registry

Abstract

Anticancer treatment-induced cardiovascular cardiotoxicity is related to cardiovascular and all-cause mortality in patients with cancer. We have evaluated the association between echocardiographic findings and all-cause mortality, especially cardiovascular mortality in our cardio-oncologic patient cohort. Totally 674 patients were included into our Cardio-Oncologic Registry, who visited our cardio-oncologic outpatient care due to suspicious cardiotoxicity. Clinical data (age, sex, date of visit, survival status, date of death, atrial fibrillation) baseline and follow-up echocardiographic data and type of cancer, routine laboratory parameter (among others troponin T, NT-proBNP, creatine), and the main oncologic diagnosis with ICD codes (retrieved from the hospital documentation) were recorded at the baseline and the at the final visiting date. The mean age of the 674 patients (346 male /51.3%/ and 328 female /48.7%) was 71±13.1 years. Permanent atrial fibrillation was recorded in 156 patients (21.3%). High proportion of patients (n=450, 66.8%) had already metastases at the first visit. Baseline echocardiography was performed in 516 (76.6%) patients, while 316 patients (46.9%) underwent follow-up echocardiography. Left ventricular function worsened in 81/316 patients (25.6%) during the mean follow-up time of 24±12 months. Both the troponin T and NT-proBNP values were already elevated at the first clinical visit, while the mild reduced kidney function did not change. Totally 204 patients (30.3%) died during the 35.2 ±18.5 months visit duration. According to the Austrian Mortality Statistics, 20 of 204 patients (9.8%) died due to cardiovascular complications. Table 1 lists the clinical, laboratory and echocardiographic data of the survival and non-survival patients. Our prospective registry involving unselected cancer patients with high incidence of metastases revealed high mortality in patients with suspected cardiotoxicity, with a relatively low incidence of 9.8% cardiovascular death.Table 1