Cardiac dysfunction among soft tissue sarcoma patients in Denmark
Authors Shantakumar S, Olsen M, Vo T, Nørgaard M, Pedersen L
Received 18 November 2015
Accepted for publication 17 February 2016
Published 15 April 2016 Volume 2016:8 Pages 53—59
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Lucy Goodman
Peer reviewer comments 3
Editor who approved publication: Professor Henrik Toft Sørensen
Sumitra Shantakumar,1 Morten Olsen,2 Thao T Vo,3 Mette Nørgaard,2 Lars Pedersen,2
1Worldwide Epidemiology Department, GlaxoSmithKline Pte Ltd, Singapore; 2Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 3Worldwide Epidemiology, GlaxoSmithkline, Research Triangle Park, USA
Purpose: Soft tissue sarcoma (STS) patients may experience post-treatment cardiotoxicity, yet no population-based data exist. We examined the incidence of left ventricular ejection fraction (LVEF) decline, heart failure, and cardiac death following STS diagnosis among adults, using Danish patient registries and medical record review.
Patients and methods: LVEF decline was examined in a regional cohort of STS patients diagnosed during 1997–2011 in Western Denmark for whom cardiac imaging data were available. LVEF decline was defined as an absolute decline from baseline to follow-up of 10% or more, or, where baseline imaging was not available, a decline below the lower limit of normal (or 40%) for a follow-up LVEF. Heart failure and cardiac death were investigated in a national Danish cohort of all STS patients diagnosed from 2000 to 2009. We followed patients from STS diagnosis until heart failure, cardiac death, emigration or December 31, 2012 (whichever occurred first).
Results: The incidence rate of LVEF decline for the regional cohort with follow-up data (N=100, five events) or baseline and follow-up measurements (N=75, 19 events) was 16.8 (95% confidence interval [CI]: 7.0–40.3) and 108 (95% CI: 69–170), respectively, per 1,000 person-years. In the national cohort (N=1,187), the incidence of heart failure (40 events) and cardiac death (15 events) was 7.3 (95% CI: 5.4–10.0) and 2.7 (95% CI: 1.6–4.5), respectively, per 1,000 person-years. The strongest predictors of heart failure were doxorubicin treatment (hazard ratio [HR] =2.2, 95% CI: 0.5–10.2) and pre-existing cardiovascular disease (HR=6.3, 95% CI: 0.98–40.6).
Conclusion: LVEF decline occurred more frequently compared to heart failure or cardiac death in a nationally representative cohort of Danish STS patients.
Keywords: sarcoma, heart failure, LVEF, cardiac death
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