Abstract Background Coronary artery calcification (CAC) scoring can be measured as a by-product of computed tomography (CT). CAC scoring reflects the general cardiovascular risk profile of patients. The aim of the present study was to determine the prognostic role of CAC on overall survival (OS) in patients with different hematological diseases undergoing allogeneic stem cell transplantation. Methods A retrospective analysis was conducted on all patients undergoing peripheral blood stem cell transplantation between January 2015 and October 2021. A total of 121 patients (68 male patients, 56.1%) with a mean age of 53.1 ± 13.6 years were identified in the data base and included into the present study. The clinical CT scan to rule out infectious foci was used to assess the CAC score for each patient. The semiquantitative Weston score was measured to quantify CAC. Results A total of 67 patients (54.9%) died during the course of the study. A total of 52 patients (42.6%) had visible calcifications on CT images, whereas 70 patients (57.4%) had no calcifications (CAC score 0). There was no association between the CAC score with OS, with an HR of 1.14 (95% CI 0.89; 1.45), p = 0.28) as a metric variable and HR of 1.33 (95% CI 0.82; 2.15) as a dichotomized variable (CAC score 0 versus positive CAC score). There was no association between CAC score and occurrence of sepsis or graft-versus host disease after transplantation. Conclusions The presence of CT-defined coronary calcifications has no prognostic relevance in patients undergoing allogeneic stem cell therapy. The impact of CT-defined cardiovascular risk factors appears to be relatively modest in this heterogeneous patient sample.
Cardiovascular disease remains the leading cause of morbidity and mortality among cancer survivors. Multiple cardiovascular risk prediction models exist to provide risk stratification for patients who are about to undergo cancer treatment. Current risk models have limited guidance on how to prevent, modify, and monitor for heart failure (HF) particularly heart failure with preserved ejection fraction (HFpEF). Cancer survivors are at an elevated risk for HFpEF due to the development of cardiometabolic syndrome associated with aging and long-term survival. Future efforts should focus on novel biomarkers in assessing HF, development of large, multicenter databases that can be used to validate models across diverse populations, and defining clear treatment pathways once risk is identified. A more comprehensive and inclusive risk stratification model with pragmatic approaches to clinical care will allow for more widespread use among cardiologists and oncologists.
Abstract Background Chimeric antigen receptor (CAR) T-cell therapy has substantially improved outcomes in refractory hematologic malignancies but may cause cardiovascular complications, particularly in the context of cytokine release syndrome (CRS). Real-world data on incidence, severity, and prognostic relevance of cancer therapy–related cardiovascular toxicity (CTR-CVT) defined by the 2022 ESC cardio-oncology guidelines remain in the context of CAR-T cell therapy limited. Methods This retrospective single-center study includes 104 patients treated with CAR T-cells between 09/2019 and 02/2024 for acute lymphoblastic leukemia, non-Hodgkin lymphoma and multiple myeloma. The primary endpoint was new-onset CTR-CVT during hospital stay, defined as cancer therapy–related cardiac dysfunction (CTRCD), arrhythmia, myocardial infarction, cardiogenic shock, or cardiovascular death. Clinical characteristics, biomarkers, echocardiographic parameters, CRS/ICANS severity, and survival outcomes were analyzed. Results Fifty-two patients (50%) met criteria for CTR-CVT, predominantly due to asymptomatic biomarker elevation. CTRCD occurred in 48.1%, whereas clinically significant events were rare: three patients developed symptomatic CTRCD, one experienced cardiogenic shock, and no myocardial infarctions or cardiovascular deaths were observed. Cardiovascular events occurred early and were associated with higher-grade CRS and ICANS, as well as elevated inflammatory markers. Reduced baseline left ventricular ejection fraction, elevated systolic pulmonary artery pressure, impaired performance status, and beta-blocker use were associated with increased CTR-CVT risk. Survival was numerically lower in patients with CTR-CVT but did not reach statistical significance. Conclusion Although half of patients fulfilled ESC criteria for CTR-CVT, clinically relevant cardiac events after CAR T-cell therapy were uncommon. These findings suggest potential overclassification driven by biomarker elevations and underscore the importance of emphasizing clinical relevance when assessing cardiotoxicity in CAR T-cell recipients.
Abstract Background Cardiovascular disease (CVD) is a major concern among cancer survivors. However, the intersection of cancer and CVD has only recently gained broader attention, and substantial evidence gaps remain. This study aimed to identify risk factors associated with incident CVD in cancer survivors and to develop a machine learning model for CVD risk prediction. Methods In this retrospective study, we included 2,500 patients receiving systemic antitumor therapy at Jilin Cancer Hospital; 188 incident CVD events were observed. Variables spanning demographic, clinical, tumor- and treatment-related, and laboratory domains were collected. The dataset was randomly split into a training set (75%) and an internal validation set (25%). Feature selection was performed using LASSO regression. Six prediction models were developed, including five machine learning algorithms (GBM, CoxBoost, XGBoost, SVM, and RSF) and a traditional Cox proportional hazards model. Model performance was evaluated using time-dependent receiver operating characteristic curves (AUC), calibration analyses, and decision curve analysis. Model interpretability was assessed using SHapley Additive exPlanations (SHAP). Results In univariate analyses, 48 variables were associated with CVD risk ( P < 0.20). LASSO regression identified 19 predictors for model development. Key predictors included elevated systolic blood pressure, specific cancer types, anthracycline use, and a history of hypertension. The XGBoost model demonstrated the best predictive performance, with an average AUC of 0.666, sensitivity of 69.8%, specificity of 60.7%, and overall accuracy of 61.4% in the internal validation set. The model showed good calibration and yielded a positive net benefit across a range of clinical thresholds. SHAP analysis indicated that cancer type, lack of anti-HER2 therapy, elevated systolic blood pressure, advanced T stage, advanced TNM stage, and higher uric acid levels were the most influential predictors. Conclusion This study developed and internally validated interpretable machine learning models to predict CVD risk among cancer survivors. The models demonstrated good discrimination and calibration and outperformed traditional methods. By enabling individualized risk quantification and providing transparent interpretation of key predictors, this approach offers a practical tool to support personalized surveillance and prevention strategies in cardio-oncology.
Abstract Background Myocardial infarction and ischemic stroke are common causes of morbidity after major cancer surgery. Understanding the risks associated with both open and laparoscopic surgery is crucial in reducing postoperative morbidity and mortality. Methods This nationwide cohort study included patients who underwent major cancer surgery in the pelvis from 2000 to 2015. The primary outcome was the incidence of myocardial infarction and ischemic stroke within 90 days postoperatively. Adjusted odds ratios (OR) were estimated using logistic regression adjusted for propensity score and risks by regression standardization. Results A total of 22,619 patients operated with laparoscopic and 70,896 patients operated with open approach were included in the analysis. The crude 90-day cumulative risks of myocardial infarction and ischemic stroke were 0.66% and 0.48%, respectively. Laparoscopic surgery was associated with lower odds of myocardial infarction within 30 days (OR 0.39, 95% CI 0.23–0.62) and 90 days (OR 0.57, 95% CI 0.41–0.81) compared to open surgery. Similarly, an association was observed for ischemic stroke (OR 0.67, 95% CI 0.38–1.05 at 30 days; OR 0.69, 95% CI 0.45–0.80 at 90 days). Conclusions Laparoscopic surgery is associated with reduced postoperative risk of myocardial infarction and ischemic stroke compared to open surgery in the treatment of pelvic cancers. These findings favor the broader adoption of minimally invasive techniques in clinical practice.
