Early abnormalities in cardiac structure and function may improve cardiomyopathy risk prediction in CCS. This study, published in JACC: Advances, evaluated whether echocardiographic parameters could identify CCS at highest risk for subsequent cardiomyopathy.

A multicenter retrospective cohort of 146 CCS (52 cardiomyopathy cases and 94 noncases) with 281 echocardiograms and a median follow-up of 9.3 years after cancer diagnosis was analyzed. Cases were defined by LV fractional shortening ≤28% or LV ejection fraction (EF) ≤50% on at least two occasions, while noncases maintained fractional shortening ≥30% and EF ≥55% without cardiac medications. Echocardiograms were centrally quantified in a blinded fashion. Least absolute shrinkage and selection operator (LASSO) regression identified the most influential two-year predictors among 27 echocardiographic parameters. Logistic regression provided odds ratios (ORs) with 95% confidence intervals (CIs), and predictive performance was assessed using the area under the receiver operating characteristic curve (AUC).

Seven echocardiographic measures were most predictive, yielding an AUC of 0.82 (95% CI: 0.74–0.89) in the training set and 0.85 (95% CI: 0.74–0.95) in the test set. LV end-systolic dimension (OR per millimeter: 1.2; 95% CI: 1.1–1.4), apical four-chamber longitudinal strain (OR per percent: 1.2; 95% CI: 1.0–1.3), and septal A’ velocity (OR per centimeter per second: 1.3; 95% CI: 1.1–1.6) were strongest. Including cancer treatment exposures did not substantially change these estimates.

These findings indicate that early echocardiographic abnormalities can reliably identify high-risk CCS who may benefit from timely cardioprotective interventions.