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Table 2 Predictive models for cardiovascular events in cancer patients

From: Evidence-based prediction and prevention of cardiovascular morbidity in adults treated for cancer

Study Population Components of model Discriminative value Strength Consecutive step
Ezaz et al. [15] From SEER database: N = 1664 pts. treated for HER2+ BC with systemic therapies 1 point: past medical history of hypertension, diabetes, or age 75–79 years.
2 points: history of coronary artery disease, renal failure, or atrial fibrillation or flutter, having received any chemotherapy or > 80 years of age
Three risk groups: low (0 to 3 points), medium (4 to 5 points), and high (≥6 points) risk strata with 3-year CE rates of 16.2, 26.0, and 39.5%, respectively Training set of 70%, internal validation in the other 30% with strong performance of the model Validation in additional external cohorts.
No information on cardiovascular medication use
Rushton et al. [16] N = 143 patients with HER2+ BC referred to a cardio-oncology clinic at a tertiary care center Sensitivity analysis to validate model composed by Ezaz et a [16] Low risk: 42% CE rate, 13% permanent HF
Moderate risk: 64% CE rate, 14% permanent HF
High risk: 30% CE rate, 20% permanent HF
Low cardiac risk score had a negative predictive value of 94% for permanent cardiotoxicity. Highly selected population.
Sub-optimal performance in high risk group.
Fogarassy et al. [8] Nationwide health care databases, N = 8068 BC pts. treated with epirubicin Risk-prediction score for HF composed of age, diabetes mellitus, hypertension, coronary artery disease, stroke, epirubicin dose, docetaxel dose, capecitabine, gemcitabine, bevacizumab and cancer stage Five score point categories and corresponding risk for HF; score 1–7 HF 2.1%, score 8–9 HF 5.0%, score 10–12 HF 10.3%, score 13–18 HF 22.1%, score 19–26 HF 31.7% Large dataset, Training set of 70%, internal validation in the other 30% Information on cardiovascular medication use.
External validation.
Romond et al. [17] Analysis from NSABP B-31 trial, N = 1830 pts. with HER2+ BC Retrospective regression analysis to reveal predictors for cardiac events: formula to calculate cardiac risk score Cardiac risk score based on age and baseline LVEF by MUGA High discriminate ability (C-index 72%) in associating the length of time to a cardiac event with the probability of not experiencing CEs. No external validation of the risk score
Hermann et al. [18] Literature- and expert-based recommendation Type of treatment, age, gender, history of CVD or presence of risk factors for CVD No statistical validation Easily accessible variables Test algorithm in patient population for clinically relevant endpoints.
Abdel-Qadir et al. [19] Real-world population EBC Ontario 2003–2015, N = 90,104 (2/3 training, 1/3 validation set) Risk-prediction score for MACE composed of age, hypertension, diabetes, ischaemic heart disease, atrial fibrillation, HF, cerebrovascular disease, peripheral vascular disease, chronic obstructive pulmonary disease, and chronic kidney disease Ten-year MACE incidence was > 40-fold higher for patients in the highest score decile compared to the lowest. The c-index was 81.9% (95% confidence interval 80.9–82.9%) at 5 years and 79.8% (78.8–80.8%) at 10 years in the validation cohort, with good agreement between predicted and observed MACE incidence. Clinically relevant long-term outcome No incorporation of cancer and treatment-related variables
Dranitsaris et al. [20] Metastatic breast cancer pts. treated with anthracyclines (doxorubicin or liposomal doxorubicin), N = 509 Risk scoring algorithm (range 0–62) based on number of cumulative cycles, patient age and weight, previous anthracycline exposure and poor performance statu A ROC analysis had an area under the curve (AUC) of 0.84 (95% CI: 0.79–0.89). A precycle risk score cutoff of ≥30 to < 40 was identified to optimally balance sensitivity (58.5%) and specificity (89.0%). Easily accesible variables Validation in external cohorts.
Add information on risk factors for CVD and medication use .
  1. Abbreviations: HER2 Human Epidermal growth factor Receptor 2, pts patients, RCT randomised controlled trial, yr year, LVEF left ventricular ejection fraction, CVD cardiovascular disease, HF heart failure, CE cardiac event