ArticleFrontiers in cardiovascular medicine2026
Baseline vs. on-treatment heart failure with preserved ejection fraction (HFpEF) in a real world cardio-oncology clinic: observational analysis of cancer therapy-related cardiovascular toxicity incidence and cancer treatment implications.
Article in Frontiers in cardiovascular medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and aims: Heart failure with preserved ejection fraction (HFpEF) prevalence increases, but in cancer patients undergoing potentially cardiotoxic treatments, HFpEF is not included in baseline risk stratification, nor in cancer therapy-related cardiac dysfunction (CTRCD) definitions. Data on HFpEF in this population are scarce. We described baseline HFpEF prevalence in cancer patients and compared incidence of cancer therapy-related cardiovascular toxicity (CTR-CVT), CTRCD and HFpEF events (new HFpEF diagnosis or decompensation of pre-existing HFpEF) and mortality in this subgroup compared to patients without pre-existing HF and to patients with pre-existing HF(m)rEF. Secondly, we investigated the incidence of HFpEF events and CTR-CVT after cancer therapy initiation, identifying predictors for developing HFpEF events. Methods and results: This retrospective analysis included 665 patients (54.1% female, mean age 62.1 years), of whom 36 (5.4%) had known HFpEF prior to cancer therapy initiation. Compared to patients without HF, pre-existing HFpEF implied higher mortality (27.8% vs. 12.8%, Conclusion: Pre-existing HFpEF carries a significant morbidity and mortality risk, where pre-existing HFpEF identifies a high-risk phenotype with elevated crude mortality, but the independent mortality signal is driven by HFrEF. HFpEF events are common and may have important cancer treatment (and therefore prognostic) implications, despite not being formally included in the definition of "CTRCD" in current guidelines. In patients developing HFpEF events, HFA-ICOS baseline risk stratification proformas suggested a low to intermediate CTR-CVT risk in most patients, possibly reflecting an underestimation of this risk and encouraging further optimization of current risk stratification tools.
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