Classification, prevalence, and outcomes of anticancer therapy-induced cardiotoxicity: The CARDIOTOX registry

José López-Sendón, Carlos Álvarez-Ortega, Pilar Zamora Auñon, Antonio Buño Soto, Alexander R. Lyon, Dimitrios Farmakis, Daniela Cardinale, Miguel Canales Albendea, Jaime Feliu Batlle, Isabel Rodríguez Rodríguez, Olaia Rodríguez Fraga, Ainara Albaladejo, Guiomar Mediavilla, Jose Ramón González-Juanatey, Amparo Martínez Monzonis, Pilar Gómez Prieto, José González-Costello, José María Serrano Antolín, Rosalía Cadenas Chamorro, Teresa López Fernández

Research output: Contribution to journalArticlepeer-review


Aim: Cardiotoxicity (CTox) is a major side effect of cancer therapies, but uniform diagnostic criteria to guide clinical and research practices are lacking. Methods and results: We prospectively studied 865 patients, aged 54.7 ± 13.9; 16.3% men, scheduled for anticancer therapy related with moderate/high CTox risk. Four groups of progressive myocardial damage/dysfunction were considered according to current guidelines: normal, normal biomarkers (high-sensitivity troponin T and N-Terminal natriuretic pro-peptide), and left ventricular (LV) function; mild, abnormal biomarkers, and/or LV dysfunction (LVD) maintaining an LV ejection fraction (LVEF) ≥50%; moderate, LVD with LVEF 40-49%; and severe, LVD with LVEF ≤40% or symptomatic heart failure. Cardiotoxicity was defined as new or worsening of myocardial damage/ventricular function from baseline during follow-up. Patients were followed for a median of 24 months. Cardiotoxicity was identified in 37.5% patients during follow-up [95% confidence interval (CI) 34.22-40.8%], 31.6% with mild, 2.8% moderate, and 3.1% with severe myocardial damage/dysfunction. The mortality rate in the severe CTox group was 22.9 deaths per 100 patients-year vs. 2.3 deaths per 100 patients-year in the rest of groups, hazard ratio of 10.2 (95% CI 5.5-19.2) (P < 0.001). Conclusions: The majority of patients present objective data of myocardial injury/dysfunction during or after cancer therapy. Nevertheless, severe CTox, with a strong prognostic relationship, was comparatively rare. This should be reflected in protocols for clinical and research practices.

Original languageEnglish
Pages (from-to)1720-1729
Number of pages10
JournalEuropean Heart Journal
Issue number18
Publication statusPublished - May 7 2020


  • Cardio-oncology
  • Cardiotoxicity
  • Chemotherapy
  • Heart failure
  • Left ventricular dysfunction
  • Myocardial injury
  • Radiotherapy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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