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Publication Date
4-29-2026
Keywords
oregon, ppmc, ppmc gme
Disciplines
Medical Education
Abstract
Background: Incidence of anti-HER2 cardiotoxicity varies widely from 3-30%. Baseline cardiac risk factors can drastically affect an individual's risk of cardiotoxicity while on anti-HER2 therapies. Risk stratification calculators like the HFA-ICOS tool can estimate relative risk of cardiotoxicity based on preceding risk factors. High risk factors: Heart failure (HF), CAD, severe valvular heart disease. Mild-moderate risk factors: HTN, DM, CKD, age 65-79, anthracycline use, arrhythmia, smoking history, BMI>30. De-intensified surveillance has been proposed for low-risk patients. Objective: Characterize incidence and predictors of cardiotoxicity in a real world population of early-stage breast cancer patients receiving anti-HER2 therapies. Evaluate incidence of cardiotoxicity among low-risk cohorts. Methods: Retrospective cohort study of n=1,156 early stage (I-III) breast cancer patients who received anti-HER2 therapy and completed baseline and surveillance echocardiography in the 7-state Providence healthcare network between 1/1/2016-3/20/2024. Primary outcome: Development of LVEF < 50% during anti-HER2. Secondary outcomes: New clinical heart failure (HF) diagnosis, any hospitalization, and all-cause mortality. LVEF ≤50% and new HF % were also obtained in low-risk cohorts: Group 1 (not high risk): No prior HF, CAD, anthracycline use; Group 2 (low-risk): One mild-moderate cardiac risk factor; Group 3 (no-risk): No preceding cardiac risk factor. Logistic regression models accounting for demographics, comorbidities, HER2 regimen, and preceding cardiac medications were performed. Conclusions: In a real-world clinical setting, anti-HER2-associated LVEF declines were uncommon but were associated with increased hospitalizations and clinical heart failure. Baseline coronary artery disease, prior heart failure, and exposure to anthracyclines were associated with higher rates of anti-HER2- associated LVEF decline. Interim analysis of low-risk cohorts demonstrated modest incidences of LVEF decline and HF, supporting the practice of continued echo surveillance in these subgroups. The cohort with zero cardiac risk factors had no cases of treatment-related LVEF decline or clinically significant heart failure, suggesting that deferred echo surveillance could be considered in this population.
Specialty/Research Institute
Graduate Medical Education
Specialty/Research Institute
Internal Medicine
