Journal of Clinical Medicine
Comorbidity Burden and Cumulative Anti-HER2 Exposure Associated with Cardiac Dysfunction in Breast Cancer: A Real-World Cardio-Oncology Cohort
By Andrea Sonaglioni, Emanuela Fossile, Maria Adelaide Pessi and 7 others.
Abstract
Background
Cancer-therapy-related cardiac dysfunction (CTRCD) remains an important complication of human epidermal growth factor receptor 2 (HER2)-targeted therapy in patients with breast cancer. Although conventional cardiovascular risk factors and serial cardiac imaging are routinely incorporated into cardio-oncology surveillance, the potential contribution of global comorbidity burden and cumulative anti-HER2 treatment exposure remains incompletely characterized. We investigated the occurrence, clinical course, and factors associated with CTRCD in a large real-world population of patients with breast cancer receiving HER2-targeted therapy.
Methods
Adult patients with breast cancer exposed to HER2-targeted therapy and undergoing longitudinal cardio-oncology surveillance at a single tertiary center were retrospectively identified over a 10-year accrual period (January 2014–December 2024). Mean individual follow-up was approximately 2.0 years (range, 0.5–9.0 years). CTRCD was defined according to the harmonized International Cardio-Oncology Society (IC-OS) definitions incorporated into the 2022 ESC Guidelines on cardio-oncology, integrating left ventricular ejection fraction (LVEF), left ventricular global longitudinal strain (LV-GLS), and cardiac biomarkers when available. Baseline comorbidity burden was quantified using the Charlson Comorbidity Index (CCI), while cumulative anti-HER2 exposure was quantified according to the total number of treatment cycles. Factors associated with CTRCD were investigated using univariable and parsimonious multivariable logistic regression.