Objective: The cardiological evaluation of cancer patients to estimate their risk of developing cardiotoxicity depends on various factors. We here aim to evaluate a new electrocardiographic (ECG) score reflecting domains of electrical and structural alterations in therapy-naïve cancer patients undergoing anti-cancer therapies to evaluate their risk of developing cardiotoxic side effects. 

 

Methods: We performed a retrospective analysis therapy-naïve cancer patients in our two university hospital centers of oncological cardiology. ECGs of all 133 patients were evaluated concerning the four ECG score parameters: Contiguous Q-waves, markers of left ventricular (LV) hypertrophy, duration of the QRS interval and JTc prolongation. The ECG score was correlated with known risk factors for the development of cardiotoxic side effects of cancer therapies. Analysis of cardiotoxicity – defined as a decrease of left ventricular ejection fraction (LV-EF) >10% to a value below 50% or a reduction of global longitudinal strain (GLS) of ≥ 15% - was performed after a short-term follow-up. 

 

Results: ECG scoring identified one third of therapy-naïve cancer patients as moderate and high risk patients (low risk group 69%, moderate risk group 25%, high risk group 7%). The ECG score was independent of classical cardio-oncological risk factors for the development of cardiotoxicity like LV-EF, elevated cardiac troponins or NT-proBNP. Incidence of cardiotoxicity was higher in moderate and risk group than in low risk group and the ECG score predicted cardiotoxicity with high sensitivity (82%), specificity (82%) and accuracy (AUC 0.8216, p < 0.0001). 

 

Conclusions: ECG scoring prior to the start of anti-cancer therapies is an easy and inexpensive way to help identify therapy-naïve cancer patients who could be at an higher risk for the development of cardiotoxic side-effects of anti-cancer therapies. Scores can help to identify patients that could benefit from cardioprotective regimens and to develop patient-specific follow-up routines.