Higher systolic pulmonary artery pressure as a predictor of anthracycline-induced cardiac dysfunction in patients with hematologic malignancies

Current predictive tools for anthracycline-related cardiotoxicity are often insufficient, highlighting the need for additional markers to refine cardiovascular risk stratification in patients undergoing this therapy.

This study aimed to evaluate whether systolic pulmonary artery pressure (sPAP) can predict anthracycline-induced cardiotoxicity in patients with hematologic malignancies.

We conducted a retrospective analysis of 170 patients with blood cancers treated with anthracyclines. Each patient underwent two echocardiographic evaluations: one before chemotherapy and one approximately one year later (median follow-up: 369 days). Cardiotoxicity was defined as a composite outcome—post-chemotherapy cardiac dysfunction (PCCD)—which included reduced left ventricular ejection fraction (LVEF), increased left ventricular end-diastolic diameter (LVEDD), and new-onset diastolic dysfunction.

The cohort consisted of 60% men, with a mean age of 57.6 years. After chemotherapy, reductions in LVEF and increases in LVEDD were commonly observed. Higher baseline sPAP values were associated with an increased risk of PCCD (odds ratio [OR] 1.059, p=0.042). This association persisted after adjusting for age and sex (OR 1.058, p=0.054). Although the predictive accuracy of sPAP was modest (area under the curve [AUC] 0.6, confidence interval [CI] 0.51–0.66), the optimal cutoff for sPAP was determined to be 32 mmHg. A trend was observed between higher sPAP and LVEF reduction, but this did not reach statistical significance. Patients with elevated sPAP were often older, male, or had ischemic heart disease. Conversely, higher tricuspid annular plane systolic excursion (TAPSE) was associated with lower sPAP values.

This study identifies elevated sPAP as a potential predictor of anthracycline-induced cardiac dysfunction. Incorporating sPAP measurements into standard assessments may improve risk stratification for patients undergoing anthracycline treatment. Further research is necessary to validate these findings and determine their clinical applicability.