Global

Cardio-Oncology
Summit
October 6-7, 2022 | Fairmont Royal York Hotel
#GCOS2022
Welcome Note
Thank you for joining us at this year’s Global Cardio-Oncology Hybrid Summit
2022. The GCOS summit models a leading-edge interdisciplinary approach
to preventative and targeted medicine in Cardio-Oncology. Together, our
interprofessional group, consisting of international, interdisciplinary health
care professionals, will review the most recent literature and research on
prevention, treatment, and monitoring strategies in Cardio-Oncology and
provide a forum for new research collaborations and networking.

Sincerely,

Dr. Christine Brezden-Masley Dr. Dinesh Thavendiranathan

Co-Chair, GCOS 2022 Co-Chair, GCOS 2022
Medical Oncologist Cardiologist
Sinai Health System Toronto General Hospital
Toronto, Ontario, Canada Toronto, Ontario, Canada
Planning Commitee
Christine Brezden-Masley MD PhD FRCPC
Associate Professor of Medicine, University of Toronto; Director, Marvelle Koffler Breast Centre; Medical
Director, Cancer Program at Sinai Health, Toronto, ON, Canada. President, Canadian Cardiac Oncology
Network
Dr. Christine Brezden-Masley is a practicing Medical Oncologist and the Director of the
Marvelle Koffler Breast Centre at Mount Sinai Hospital. She is the Medical Director of
the Cancer Program at Sinai Health System. She obtained her PhD in Medical Biophysics
at Princess Margaret Hospital in Toronto and her Medical Degree from the University
of Toronto. She is currently an Associate Professor at the University of Toronto, an
Associate Scientist at the Lunenfeld Tanenbaum Research Institute, and an Associate
Scientist at the Li Ka Shing Knowledge Institute.

Dinesh Thavendiranathan MD SM FRCPC FASE

Director, Ted Rogers Program in Cardiotoxicity Prevention, Toronto General Hospital, Associate Professor of
Medicine; University of Toronto, Toronto, ON, Canada, Toronto General Hospital
Dr. Paaladinesh Thavendiranathan MD, SM, FRCPC, FASE is a cardiologist at the Toronto
General Hospital, University of Toronto. He is an Associate Professor of Medicine and
a Clinician Investigator. His training was in advanced cardiovascular imaging and his
current clinical practice involves work with cardiac MRI, CT, and echocardiography. He
is the Director of the Ted Rogers Program in Cardiotoxicity Prevention which focuses on
cardiac toxicity from systemic therapies including cancer therapy. His research focus is
in the use of advanced cardiac imaging techniques for detection and management of
cardiac toxicity.

Anne Blaes MD MS
Associate Professor, University of Minnesota; Hematology/Oncology, Section Head, Medical Oncology,
Director of Cancer Survivorship Services and Translational Research, Masonic Cancer Center
Dr. Anne Blaes is an Associate Professor in the Division of Hematology and Oncology
at the University of Minnesota. She is the section head of Medical Oncology within
this division and is Director of Cancer Survivorship Services and Translational Research
within the Masonic Cancer Center. She is an active medical oncologist with a special
interest in the late effects of cancer therapy, particularly in the area of cardio-oncology.

Joseph Carver MD
Bernard Fishman Clinical Professor of Medicine; Chief Operating Officer, Abramson Family Cancer Research
Institute; Chief of Staff, Abramson Cancer Center of the University of Pennsylvania, Philadelphia, PA, USA

Dr. Joseph Carver is the Bernard Fishman Clinical Professor of Medicine at the Abramson
Cancer Center of the University of Pennsylvania, the Chief Operating Officer of the
Abramson Family Cancer Research Institute of the Abramson Cancer Center of the
University of Pennsylvania and the Chief of Staff of the Abramson Cancer Center. His
clinical practice is in the sub-specialty of cardio-oncology. He was the recipient of the
IS Ravdin Master Clinician Award at Penn in 2012. He is one of the Founding Editors of
Cardio-oncology Journal.

Susan Dent MD FRCPC

Professor of Medicine, Associate Director of Breast Cancer Research and Co-Director of Cardio-Oncology,
Duke University, Durham, NC, USA; Founder & Past-President, Canadian Cardiac Oncology Network
Dr. Susan Dent is a Professor of Medicine, Associate Director of Breast Cancer Research
and Co-Director of Cardio-Oncology at Duke University. She obtained her MD at
McMaster University and completed her postgraduate training in Internal Medicine at
the University of Ottawa. She continued her training in Medical Oncology in Ottawa,
followed by a fellowship year in Clinical Research with the Canadian Cancer Trials
Group. Her areas of research interest include breast cancer, and treatment related
toxicities with a particular interest in cardiotoxicity.
Michael G. Fradley MD
Associate Professor of Medicine, University of South Florida; Cardiologist and Director, Cardio-Oncology
Program, Moffitt Cancer Center and Research Institute, Tampa, FL, USA, Moffitt Cancer Center and Research
Institute, Tampa, FL, USA
Dr. Fradley is an Associate Professor of Medicine at the University of South Florida with
a joint appointment at Moffitt Cancer Cente. He is the director of the combined Moffitt
Cancer Center-University of South Florida Cardio-Oncology program. He earned his
B.S at Yale University and his MD degree at the Johns Hopkins University School of
Medicine. He remained at Johns Hopkins for internal medicine residency and then went
on to complete fellowships in both cardiology and clinical cardiac electrophysiology at
Massachusetts General Hospital.

Daniel J. Lenihan MD FACC

Professor of Medicine; Director, Cardio-Oncology Center of Excellence, Washington University Medical
Center, St Louis, MO, USA. President, International Cardio-Oncology Society
Dr. Lenihan, has been active in cardio-oncology and heart failure, for over 25 years.
The main focus of these efforts have included hemodynamic assessments, angiogenic
growth factor response, novel cardiac biomarkers as well as optimal methods to prevent
or detect heart failure at the earliest stage possible in patients undergoing treatment
for cancer. He has previously held positions at MD Anderson Cancer Center in Houston
and Vanderbilt University prior to becoming the Director, Cardio-Oncology Center of
Excellence at Washington University in St Louis in Sept 2017.

Teresa Lopez-Fernandez MD
Associate Professor, University of Minnesota; Hematology/Oncology, Section Head, Medical Oncology,
Director of Cancer Survivorship Services and Translational Research, Masonic Cancer Center
Dr. Anne Blaes is an Associate Professor in the Division of Hematology and Oncology
at the University of Minnesota. She is the section head of Medical Oncology within
this division and is Director of Cancer Survivorship Services and Translational Research
within the Masonic Cancer Center. She is an active medical oncologist with a special
interest in the late effects of cancer therapy, particularly in the area of cardio-oncology.

Alexander Lyon MA BM BCh PhD FRCP FHFA

Senior Lecturer in Cardiology, Imperial College London; Consultant Cardiologist & Clinical Lead for Cardio-
Oncology Service, Royal Brompton Hospital, London, United Kingdom. President, British Cardio-Oncology
Society
Dr. Alexander Lyon is a Senior Lecturer in Cardiology at Imperial College London and
a Consultant Cardiologist at the Royal Brompton Hospital. His clinical interests are in
the field of heart failure, cardio-oncology including chemotherapy cardiomyopathy and
the cardiovascular complications of modern cancer therapies, Takotsubo syndrome and
the effects of major stresses of the heart, and the development of novel therapeutics
including gene therapy for chronic heart failure. Alex has published 137 scientific
papers in peer-reviewed journals, several book chapters in cardiology textbooks, he
is an associate editor of the European Journal of Heart Failure, and his H-index is 35.

Sebastian Szmit MD PhD

Associate Professor of Medicine; Cardiologist & Specialist of Internal Medicine, Centre of Postgraduate
Medical Education, Otwock, Warsaw, Poland
Sebastian Szmit graduated from the Military Medical Academy in Poland, worked
as an internal medicine doctor in the Emergency Department, Internal Diseases and
Cardiology Clinic and Oncology Clinic in the Military Institute of Medicine (2003-2012)
and in the Laboratory of Exercise Tests in the Central Hospital of the Medical University
of Warsaw (2007-2012). From 2012 he is the Cardio-Oncology Consultant and the Chief
of the Laboratory of Cardio-Pulmonary Exercise Testing in the Department of Pulmonary
Circulation, Thromboembolic Diseases and Cardiology, Centre of Postgraduate Medical
Education at the European Health Centre in Otwock.
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WIFI Hybrid Conference
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Pre-Conference Wednesday, October 5, 2022
Cardiac Imaging/Clinical Cases
Location: Peter Munk Cardiac Centre, Toronto General Hospital

Time Topic Panel/Speaker

12:30 Registration

Track 1
Echocardiography
Chairs: Dr. Jennifer Liu and Dr. Teresa Lopez-Fernandes

1:00 Philips/GE – Hands-on Imaging Session

2:50 Break with Snacks

3:10 Philips/GE – Hands-on Imaging Session

Track 2
Cardio-Oncology Clinical Case Series Symposium
Chairs: Dr. Christine Brezden-Masley and Dr. Juan Carlos-Plana Gomez

Dr. Susan Dent

3:00 Anthracycline and HER2
Dr. Daniel Lenihan

Dr. Tomas Neilan

3:40 ICI myocarditis – treatment
Dr. Parneet Cheema

Dr. Anju Nohria

4:20 Chest pain with 5FU/capecitabine
Dr. Bindi Dhesy-Thind

Pre-Conference Wednesday, October 5, 2022

Inaugural Nursing Focused Cardio-Oncology Conference
Location: Princess Margaret Hospital

Time Topic Panel/Speaker

1:00 Welcome and Introductions Anecita Fadol

Inaugural Nursing Preconference Sessions 1 and 2

Moderators: Molly Rater

Foundational Building Blocks for a

1:15 Janet Celli, Anecita Fadol
Successful Cardio-Oncology Program
 “Strength Matters”: Importance of
Cardiac Surveillance for Anthracy-
Coleen Power, Jordan Rivera
2:15 cline-based chemotherapy regimens
with subsequent treatment with HER-
2 Targeted Therapy

Inaugural Nursing Preconference Sessions 3 and 4

Moderators: Kerry Skurka and Trent Williams

Safe for “Oral Consumption”… but

are they really? Importance of aware-
3:00 ness of some oral therapies and im- Dr. Vijay Rao
munotherapies potential cardiac side
effects

Congratulations, you “rang the bell!”

Kerry Skurka, Debra Spoiljaric, Mary
3:45 What is next for Survivorship support
Stuart, Susan Mehta
and programs?

4:45 Evaluation and Closing Anecita Fadol

Program Thursday, October 6, 2022

Time Topic Speaker Location

Tudor
7:00 Breakfast (provided) & Registration
Mezzanine Level

Co-Chairs:
GCOS 2022 Welcome & Dr. Christine Brezden-Masley Imperial
8:00
Introduction & Dr. Dinesh Thavendirana- Ground Level
than

Session 1
Opening Plenary Lecture and Patient Perspectives
Chairs: Dr. Susan Dent & Dr. Ana Barac

8:15 Patient Perspectives Patient #1

Cardio-Oncology 2022:
Where Have we Been, Dr. Bonnie Ky
8:25
Where are we Now and
Where are we Going?

ESC Guidelines Update – Dr. Teresa Lopez-Fernandes &

8:55
The Highlights Dr. Alexander Lyon

9:15 Discussion

ICOS Chapter Update –

9:25 Dr. Trishun Singh
South Africa
 Tudor
9:35 Break with Snacks (provided)
Mezzanine Level

Session 2
Imperial
Hematology
Ground Level
Chairs: Dr. Negareh Mousavi and Dr. Keith Stewart

Case Presentation by a
9:50 Dr. Rocio Consuelo Baro Vila
fellow

9:55 Multiple Myeloma Dr. Joesph Mikhael

Bone Marrow Transplant

10:15 and Cellular-based therapies Dr. Iskra Pusic
in Hematology

Use of CAR-T Cells to Treat

10:35 cardiovascular disease: Is Dr. Saad Mahmood
that the future?

Vascular toxicities from

Dr. Diego Delgado
10:55 treatment of hematological
malignancies

Panel Discussion and Questions

11:15
Integration of case presented

Session 3
Imperial
Plenary Lecture
Ground Level
Chairs: Dr. Dipti Gupta & Dr. John Dick

Clonal Hematopoesis:
A Recently Recognized
11:30 Link between Cancer, Dr. Peter Libby
Cardiovascular Disease, and
Aging

12:00 Questions and Discussion

ICOS Chapter Update –

12:20 Dr. Matthias Totzeck
Germany

12:30 Lunch (provided)

Session 4
Imperial
Radiation Oncology
Ground Level
Chairs: Dr. Ludhmila Hajjar & Dr. Tharshini Ramalingam

Case Presentation by a
1:30 Dr. Henry Su
cardiologist

Surgical Management of
Dr. Tirone David
1:35 Valve Complications from
Radiation Therapy
 Promising Predictors
1:55 of Acute and Chronic Dr. Caroline Chung
Cardiotoxicity

Radiation Techniques to
2:15 Dr. Anne Koch
Prevent Cardiotoxicity

Panel Discussion and Questions

2:35
Integration of case presented

Tudor
2:50 Break with Snacks (provided)
Mezzanine Level

Session 5
Imperial
Keynote Debate
Ground Level
Chairs: Dr. Ian Paterson & Dr. Parneet Cheema

The risk of myocarditis is

low, but it is deadly. Should Yes:
a Cardio-Oncology assess- Dr. Tomas Neilan
3:05 ment be recommended for
all patients prior to and No:
during immunotherapy Dr. Rosalyn Juergens
treatment?

Session 6
Young Investigators Competition Imperial
Chairs: Dr. Eitan Amir, Dr. Teresa Lopez-Fernandes , Dr. Joseph Ground Level
Carver, Dr. Thomas Suter, & Dr. Ariane Macedo

Three-Year Outcomes
Following Permissive
Cardiotoxicity in Patients Dr. Shijie Zhou
with Breast Cancer Treated
with Trastuzumab

Efficacy and Safety of

3:30 Catheter Ablation for Atrial
Dr. Sonu Abraham
Fibrillation in Patients with
History of Cancer

Cancer Therapy-Related
Cardiotoxicity: Is the
Dr. Dakota Gustafson
Endothelium at the Heart of
the Matter?

Thomas Force Leadership in Cardio-Oncology Lecture

Imperial
4:15 Dr. Susan Dent (Oncologist, USA)
Ground Level
Presented by: Dr. Bonnie Ky

Poster Reception Confederation

5:00
(with Wine and Cheese Reception) Mezzanine Level

Hockey Hall of
7:00 GCOS 2022 Event Dinner
Fame
Program Friday, October 7, 2022
Time Topic Speaker Location

Tudor
7:30 Breakfast (provided)
Mezzanine Level

Co-Chairs:
Imperial
8:00 Opening Remarks Dr. Christine Brezden-Masley &
Ground Level
Dr. Dinesh Thavendiranathan

Announcement of the
Dr. Eitan Amir
8:10 Young Investigator
Dr. Teresa Lopez-Fernandes
Award Winner

8:15 Patient Perspectives Patient #2

8:25 ICOS Overview Dr. Susan Dent

Session 7
Imperial
Plenary Lecture
Ground Level
Chairs: Dr. Jean Bernard Durand & Dr. Abha Gupta

Cardiac Surveillance in
AYA Cancer Survivors:
8:40 What Evidence is Dr. David Hodgson
Needed to Improve
Practice Guidelines?

9:10 Questions and Discussion

ICOS Chapter Update –

9:15 Dr. Juliana Sales Segura
Costa Rica

Session 8
Imperial
Survivorship
Ground Level
Chairs: Edith Pituskin and Dr. Erin Howden

9:25 Case Presentation Dr. Fernando Rivera Theurel

The Role of Exercise

in Mitigating
9:30 Dr. Erin Howden
Cardiovascular Disease
in Cancer Survivors

Acute and Late

Cardiotoxicity in Adult
9:50 Dr. Paul Nathan
Survivors of Pediatric
Cancers
 Strategies for Long
term Monitoring and
10:10 Intervention in Survivors Dr. Zaza Iakobishvili
of Adult Cancers: Where
are the Guidelines?

Panel Discussion and Questions

10:30
Integration of case presented

Tudor
10:45 Break with snacks (provided)
Mezzanine Level

Session 9
Imperial
Flash Updates in Oncology Impacting the Heart
Ground Level
Chairs: Dr. Margot Davis & Dr. Bindi Dhesy-Thind

Breast Cancer: Beyond

11:00 Trastuzumab and Dr. Christine Simmons
Anthracyclines

Considerations in
11:15 Dr. Darryl Leong
Prostate Cancer

Lung Cancer and

11:30
Cardiovascular Toxicity: Dr. Natasha Leighl
State of the Art in 2022

AL Amyloidosis: Where
11:45 Dr. Ashutosh Wechalekar
are we Now?

12:00 Panel Discussion and Questions

ICOS Chapter Update -

12:15 Dr. Andreia Magalhaes
Portugal

12:25 Lunch (provided)

Session 10
Imperial
Innovation Lecture
Ground Level
Introduced by: Dr. Michael Fradley

The Role of Artificial

Intelligence in Promoting
1:30 Dr. Peter Noseworthy
Precision Medicine in
Cardio-Oncology

1:55 Discussion and Questions

Session 11
Imperial
Cracking the Code of Early Diagnostics
Ground Level
Chairs: Dr. Jennifer Liu & Dr. Juan Carlos Plana Gomez
 Role of CMR in Cardio-
2:05 Dr. Greg Hundley
Oncology

Role of
2:20 Echocardiography in Dr. Thomas Marwick
Cardio-Oncology

Integrating Biomarkers
2:35 Dr. Daniela Cardinale
into Clinical Practice

2:50 Panel Discussion and Questions

ICOS Chapter Update -

3:05 Li Ling Tan
Singapore

Tudor
3:15 Break with Snacks
Mezzanine Level

Session 12
Imperial
Arrhythmias / Thrombosis
Ground Level
Chairs: Dr. Kibar Yared and Dr. Agnes Lee

3:30 Case Presentation

Atrial Arrhythmias
3:35 During Cancer Treatment Dr. Husam Abdel-Qadir
and in Cancer Survivors

Ventricular Arrhythmias
3:55 and Sudden Cardiac Dr. Joe Elie Salem
Death

Cancer Associated
4:15 Dr. Sebastian Szmit
Thrombosis

ICOS Universal
4:35 Dr. Joerg Herrmann
Definitions Updates

4:55 Panel Discussion and Questions

Co-Chairs:
Closing Remarks/
5:15 Dr. Christine Brezden-Masley &
Adjourn
Dr. Dinesh Thavendiranathan
Global Cardio-Oncology Summit 2022 Oral Abstracts
O1
Authors
Shijie Zhou, McMaster University, Filipe Cirne, McMaster University, Justin Chow, McMaster University, Arman Zereshkian, McMaster
University, Nazanin Aghel, McMaster University, Darryl Leong, McMaster University

Three-Year Outcomes Following Permissive Cardiotoxicity in Patients with Breast Cancer Treated with
Trastuzumab
Submission ID 1293295
Background
Trastuzumab improves survival in patients with HER2 positive breast cancer. Cardiotoxicity, manifest by re-
duced left ventricular ejection fraction (LVEF) is the most common reason for its premature discontinuation.
While permissive cardiotoxicity (where mild cardiotoxicity is accepted to enable ongoing trastuzumab) has
been shown feasible, the longer-term outcomes are unknown.
Method
We performed a retrospective cohort study of patients referred to the cardio-oncology service at McMaster
University from 2016-2021 for LV dysfunction following trastuzumab administration.
Results
We identified 52 patients who underwent permissive cardiotoxicity (7 patients with stage IV disease). The
median (25th-75th percentile) follow-up time was 2.9 years (1.21 to 4 years). Forty-seven (92%) completed
trastuzumab as planned while four (8%) prematurely discontinued trastuzumab because of cardiotoxicity;
one stopped therapy by choice despite clinical tolerance. At the end of follow-up, of the four patients who
did not tolerate permissive cardiotoxicity, three (75%) had persistently depressed LV function. In those who
completed planned trastuzumab, on average, strain returned to baseline by 6 months, but LVEF recovery was
delayed until 18 months. None of the 52 patients had any long-term cardiovascular complications during
follow-up. The only differences in baseline characteristics between those who tolerated versus did not toler-
ate permissive cardiotoxicity were a history of at least moderate valvular disease (p=0.0008) and cumulative
anthracycline dose (236.9±19.8 vs 342±167.3 mg/m2, p=0.001).
Conclusion
The novel finding of our study is that systolic LV function normalises with a strategy of permissive cardiotoxic-
ity but may take more than 18 months; 8% did not tolerate permissive cardiotoxicity, potentially related to a
higher cumulative anthracycline dose and pre-existing valvular disease.

O2
Authors
Dakota Gustafson, University Health Network, Crizza Ching, University of Toronto, Rick Lu, University of Toronto, Yimu Zhao, University of
Toronto, Jennifer Kieda, University of Toronto, Milica Radisic, University of Toronto, Eitan Amir, University of Toronto, Husam Abdel-Qadir,
Women’s College Hospital, Jason Fish, University of Toronto, Paaladinesh Thavendiranathan, University Health Network

Cancer Therapy-Related Cardiotoxicity: Is the Endothelium at the Heart of the Matter?

Submission ID 1304453
Background
Breast cancer treatments can result in cancer-therapy related cardiac dysfunction (CTRCD). Given that chemo-
therapy first comes in contact with blood vessels, we hypothesized that endothelial-derived molecules could
serve as sensitive predictors of CTRCD risk.
Method
We prospectively recruited adult women with HER2+ breast cancer treated with sequential anthracycline and
trastuzumab (EMBRACE-MRI trial). These patients had cardiac magnetic resonance (CMR) imaging and blood
collection before cancer therapy and every three months during treatment. CTRCD was defined using the
CREC criteria with CMR. To identify a vascular signature for CTRCD, multi-omic technologies (i.e., multiplex
endothelial-centric profiling, inflammatory profiling, and microRNA sequencing) were applied to isolated pa-
tient plasma and extracellular vesicles (EVs) to examine early biomarkers of CTRCD risk.
Results
Of the 136 recruited patients (age: 51.0±9.2 years) 37 developed CTRCD (36/37 events occurred at 6-14
months after initiation of therapy). The endothelial-centric biomarkers Ang-2 (CTRCD 3227±1029 pg/mL vs
No CTRCD 1990±552 pg/mL; P< 0.001) and Endoglin-1 (CTRCD 3536±1029 pg/mL vs No CTRCD 2978±605
pg/mL; P=0.003) were significantly elevated prior to cancer therapy while E-Selectin (CTRCD 88276±18274
pg/mL vs No CTRCD 66071±15486 pg/mL; P< 0.001) and ET-1 (CTRCD 7.0±1.8 pg/mL vs No CTRCD 4.8±1.6
pg/mL; P< 0.001) were elevated three months after therapy initiation. Higher pre-therapy levels of INFα (P<
0.001), IL-10 (P=0.028), and interferon gamma induced protein 10 (P< 0.001), as well as lower IL-1β (P=0.004),
were also observed in patients who developed CTRCD. Pre-therapy transcriptomic miRNA analysis revealed
stark expression differences in both plasma (n=119 differentially regulated miRNAs) as well as isolated EVs
(n=588 differentially regulated miRNAs) between groups while pathway enrichment revealed overrepresenta-
tion of senescence and inflammation processes in the CTRCD group.
Conclusion
Our results demonstrate that biomarkers of pre-existing or early endothelial dysfunction could serve as risk
markers of CTRCD, and that associated cellular processes, in particular cellular senescence and chronic in-
flammation, may contribute to its eventual development; highlighting a potential new paradigm in CTRCD
risk stratification.

O3
Authors
Sonu Abraham, Lahey Hospital & Medical Center, Rohan Parikh, Lahey Hospital & Medical Center, Rushin Patel, Lahey Hospital & Medical
Center, Amudha Kumar, University of Arkansas for Medical Sciences, Victor Lui, Beth Israel Deaconess Medical Center, Nathalie Rosas,
Beth Israel Deaconess Medical Center, Aarti Asnani, Beth Israel Deaconess Medical Center, Anju Nohria, Brigham and Women’s Hospital,
Sarju Ganatra, Lahey Hospital & Medical Center

Efficacy and Safety of Catheter Ablation for Atrial Fibrillation in Patients with History of Cancer
Submission ID 1304905
Background
Shared epidemiology, risk factors and adverse effects of anti-neoplastic therapies have led to an increased
incidence of atrial fibrillation (AF) in patients with cancer. Increasing evidence supports the superiority of early
rhythm control with catheter ablation (CA). However, the role of CA for AF management in patients with can-
cer is not well studied.
Method
A retrospective cohort study of patients who underwent CA for AF between January 1st 2004 and July 24th
2019 was performed. Patients with either a history of cancer (excluding non-melanotic skin cancers) within
5-years prior to the index ablation or those with an exposure to anthracyclines and/or thoracic radiation
at any time before were included. The control group had patients without a history of cancer, exposure to
chemotherapy or thoracic radiation. The primary outcome was freedom from AF at 12 months post-ablation
with or without anti-arrhythmic drugs (AAD). Secondary end-points included freedom from AF at 12 months
post-ablation with and without AADs and redo CA for AF. Safety endpoints included bleeding, pulmonary
vein stenosis, stroke and cardiac tamponade. Multivariate regression analysis (MVRA) was performed to iden-
tify independent risk predictors.
Results
251 (50%) out of 502 patients who underwent catheter ablation for AF, had a diagnosis of cancer within
5-years prior to the index ablation with exposure to systemic anthracyclines and/or thoracic radiation therapy.
Breast cancer was the most common cancer diagnosis (50, 19.9%). There was no difference in the primary out-
come of freedom from AF at 12 months post-ablation with or without AAD between those with and without
cancer (83.3% vs 72.5%, p 0.28). Requirement of a second redo-ablation was no different between the two
groups (20.7% vs 27.5%, p 0.29). BMI was identified as a predictor of recurrence of atrial fibrillation 3 months
after ablation in both groups on MVRA whereas cancer history of cancer or therapy were not associated with
recurrent AF. There was no difference in the incidence of complications including access and non-access site
bleeding, stroke, cardiac tamponade and pulmonary vein stenosis.
Conclusion
Catheter ablation is a safe and effective treatment for AF in patients with history of cancer and in those with
exposure to potentially cardiotoxic therapy.
Global Cardio-Oncology Summit 2022 Top 5 Posters
P1
Authors
Sean Cai, University of Toronto, Neil Dwyer, Dalhousie University, Lee Jonat, University of British Columbia, Anil Kapoor, McMaster
University, Victor Mak, Mackenzie Health, Zeid Mohamedali, Vancouver Island Health Authority, Bobby Shayegan, McMaster University,
Paul Ouellette, Centre Médical Robinson

Real-world Cardiovascular Disease Prevalence in a Canadian Population of Prostate Cancer Patients

Treated with Degarelix
Submission ID 1295681
Background
Degarelix is a gonadotropin releasing hormone (GnRH) antagonist that rapidly suppresses and maintains
testosterone levels below castrate levels. Previous studies suggested that GnRH antagonists such as degarelix
are associated with significantly lower incidences of cardiovascular events, cardiovascular death, and all-cause
mortality compared with GnRH agonists. In this study, we aim to provide practical real-world insights into a
Canadian population of prostate cancer patients receiving degarelix and their background cardiovascular
comorbidities.
Method
The Canadian Prospective Survey Program is a multi-center observational survey-based study from April 2016
to April 2019 designed to collect information in patients receiving degarelix , including baseline prevalence
of cardiovascular diseases. Parameters collected included age, disease state, clinical stage, prostate specific
antigen (PSA) value, Gleason score, and cardiovascular disease (CVD) status. CVD manifestations collected
included myocardial infarction, angina, heart failure, stroke, and transient ischemic attacks (TIA). The initial
survey was completed at the time of first injection of degarelix by the treating physician. Results were reported
as aggregate data for all patients completing the survey.
Results
A total of 1,340 initial surveys were collected across 88 sites in Canada. At their first injection, 72% of patients
were 70 years old or greater. 58% had a Gleason score of 8 or higher. More than half of patients had a
PSA score of 20 or greater (54%). Most patients were newly diagnosed (59%), and slightly under half of
patients (46%) presented with metastatic disease. 59% of the patients had no previous CVD reported, while
33% reported previous MI, TIA, Angina, HF, stroke, or other CVD either alone or in combination. The most
frequently reported CVD was MI (12%), followed by stroke and TIA (9%), angina (8%), and heart failure (4%).
8% of patients had unknown CVD status.
Conclusion
In this real-world study of 1340 patients receiving ADT for prostate cancer, we identified high prevalence
of CVD. These patients are often at high cardiovascular risk and frequently remain under-treated for their
cardiovascular risk factors. Future real word data assessing these risks and understanding the barriers to
treatment will be important as the utilization of ADT increases.
_______________________________________________________________________________________

P2
Authors
Stephen Dobbin, University of Glasgow, Kenneth Mangion, University of Glasgow, Piotr Sonecki, NHS Greater Glasgow and Clyde, Giles
Roditi, NHS Greater Glasgow and Clyde, Rob Jones, University of Glasgow, Rhian Touyz, McGill University, Mark Petrie, University of
Glasgow, Ninian Lang, University of Glasgow

Persistent Left Ventricular Dysfunction with Vascular Endothelial Growth Factor Inhibitors Despite Blood
Pressure Control: Comprehensive Cardiovascular Assessment in Patients with Cancer
Submission ID 1304465
Background
Vascular endothelial growth factor inhibitors (VEGFI) are associated with cardiovascular toxicity such as
hypertension and left ventricular systolic dysfunction (LVSD). The onset, frequency and magnitude of these
toxicities are poorly defined. LVSD may result from direct cardiac toxicity or secondary to hypertension, but
this remains unproven.
Method
Cancer patients commencing VEGFI were enrolled prospectively (Beatson West of Scotland Cancer Centre,
UK). Comprehensive cardiac and vascular assessment was performed at baseline before VEGFI and at 4, 12
and 24 weeks of treatment (Fig A). Stress perfusion cardiac magnetic resonance imaging (CMR) was performed
in a subgroup at baseline, 4 and 24 weeks. Hypertension was defined as home blood pressure (BP) ≥135/85
mmHg or new anti-hypertensive therapy. Cardiotoxicity was defined as a drop in left ventricular ejection
fraction (LVEF) to < 50% in line with International Cardio-Oncology Society definitions.
Results
Of 97 patients enrolled, 78 attended follow-up and, of these, 53 (68%) were male
with a mean age of 63 ± 11 years. Forty (51%) received VEGFI alone and 38 (49%)
received VEGFI and immunotherapy. The CMR sub-study enrolled 46 patients.
Forty-seven patients (60%) developed hypertension. Systolic and diastolic BP rose within 1
week from baseline (135 vs 128 mmHg, p< 0.001; 82 vs 78 mmHg, p< 0.001, respectively) and
persisted at 4 weeks (p< 0.001) but were well-controlled with antihypertensive therapy thereafter.
Fifteen patients (19%) developed cardiotoxicity. Overall, LVEF and global longitudinal strain (GLS)
by echo declined at 4 weeks (60% vs 64%, p=0.0008 and -17.9% vs -19.0%, p=0.0113, respectively)
and this persisted at 24 weeks. BP did not differ between those with and without cardiotoxicity (Fig B).
In the CMR sub-study, LVEF fell at 4 weeks, and this persisted at 24 weeks (51% vs 56%, p=0.0001 and 52%
vs 56%, p=0.0002, respectively) (Fig C). Resting myocardial blood flow (MBF) was reduced after 4 weeks (82
vs 97 ml/100ml/min, p=0.0047) (Fig D) but there was no difference in stress MBF (p=0.6319).
Conclusion
VEGFI-induced hypertension and cardiotoxicity occur early. Cardiotoxicity appears to persist, despite BP
control. Cardiotoxicity may be a result of direct myocardial and microvascular effects that are at least partly
independent of hypertension.
_______________________________________________________________________________________

P3
Authors
Muhummad Sohaib Nazir, Royal Brompton Hospital, Daniel Hughes, King’s College London, Gitasha Chand, NanoMab, Kathyrn
Adamson, Guy’s and St Thomas Hospital, Jessica Johnson, Guy’s and St Thomas Hospital, Damion Bailey, Guy’s and St Thomas Hospital,
Victoria Gibson, Guy’s and St Thomas Hospital, Hong Hoi Ting, NanoMab, Alexander Lyon, Royal Brompton Hospital, Gary Cook, King’s
College London

[99mTc]-labeled Anti-Programmed Death-Ligand 1 (PD-L1) Single-domain Antibody (NM-01) SPECT/CT:

A Novel Imaging Biomarker for Non-invasive Myocardial PD-L1 Expression
Submission ID 1304550
Background
Myocardial programmed death-ligand 1 (PD-L1) expression may have a potential role in immune checkpoint
inhibitor (CPI) myocarditis. We aimed to determine the non-invasive assessment of myocardial
PD-L1 expression using [99mTc]-labeled anti-PD-L1 single-domain antibody (NM-01) SPECT/CT.
Method
Thoracic [99mTc]NM-01 SPECT/CT was performed in advanced non-small cell lung cancer patients (n=10) at
baseline and 9-weeks following anti-Programmed Cell Death Protein 1 (PD-1) therapy. Baseline and 9-week left
ventricular to blood pool ratios (LVmax:BP) and right ventricular to blood pool ratios (RVmax:BP) were measured.
Results
Myocardial PD-L1 expression was evident in all patients at baseline and follow up. Mean
LVmax:BP values were 2.9±0.63 at baseline vs 2.60±0.82 at 9-weeks (p=0.37). Mean RVmax:BP
were 1.74±0.28 at baseline vs 1.68±0.51 at 9-weeks (p=0.71). There were no reported major
immune-related adverse cardiovascular events or myocarditis during the follow up period.
Conclusion
This study is the first to report that PD-L1 expression of the heart can be measured. Importantly, PD-L1
expression can be quantified non-invasively by imaging without the need for invasive myocardial biopsy. This
important finding now provides the foundation to investigate the role of PD-L1 in CPI myocarditis.
_______________________________________________________________________________________

P4
Authors
Marie Fortin, Jazz Pharmaceuticals, Andrew LaCroix, StemoniX, Qi Wang, Jazz Pharmaceuticals, Tom Grammatopoulos, BioEnergetics,
Dino Manca, Jazz Pharmaceuticals

Relative Cardiotoxicity of CPX-351 Compared to Daunorubicin Plus Cytarabine Free Drug Combination
in HiPSC-derived Cardiomyocytes
Submission ID 1304942
Background
The potential benefits of the liposomal formulation of anthracyclines on their cardiotoxicity profiles have
long been hypothesized, but have only been adequately documented for liposomal doxorubicin, for which
clinical studies are available. Here, we sought to develop an in vitro model capable of recapitulating observed
clinical differences between formulations to study the relative toxicity of CPX-351, a dual-drug liposomal
encapsulation of daunorubicin and cytarabine at a 1:5 synergistic ratio, versus the free drug combination.
Method
We developed the model and established proof of concept by treating human-induced pluripotent stem cell–
derived cardiomyocytes (hiPSC-CM) with equivalent concentrations of liposomal versus free doxorubicin and
demonstrated systematic differences in toxicologic responses between the 2 formulations. We then repeated
the study with our compounds of interest, CPX-351 versus free daunorubicin + cytarabine. hiPSC-CM were
treated for 24 hours on Days 1, 3, and 5 at concentrations ranging from 0 to 1,000 ng/mL. Mitochondrial
respiration, intracellular ATP, release of lactate dehydrogenase (LDH), release of cardiac biomarkers (cardiac
troponin I [CTnI], fatty acid–binding protein 3 [FABP3], brain natriuretic peptide [BNP], and N-terminal
proBNP), and rhythmicity were evaluated on Days 2, 4, 6, or 8.
Results
Vehicle control–treated cells displayed relatively stable profiles over the duration of the study. Microscopic
imaging suggested dose-dependent cumulative cytotoxicity of the free drugs. Free drug treatment caused
significant time- and dose-dependent decreases in oxygen consumption rates versus treatment with liposomal
formulations (P < 0.05). ATP content decrease was more profound in hiPSC-CM exposed to the free drugs.
Repeated exposure to free drugs was associated with greater biomarker (FABP3 and CTnI) and LDH release
versus the liposomal formulations, as well as a biphasic response in the beat rate (initial increase and slowing/
arrest of beating), indicating significant injury.
Conclusion
Overall, at equivalent concentrations administered on the same schedule, liposomal formulations were
considerably less toxic to hiPSC-CM than their free active counterparts. Clinical data will be needed to confirm
the findings of this in vitro model.
_______________________________________________________________________________________

P5
Authors
Ashish Kumar, Cleveland Clinic Health System, Sourbha S. Dani, Lahey Hospital & Medical Center, Safi U. Khan, Houston Methodist
Hospital, Rishi Wadhera, Beth Israel Deaconess Medical Center, Tomas neilan, Massachusetts General Hospital, Paaladinesh
Thavendiranathan, Toronto General Hospital Research Institute (TGHRI), Ana Barac, Georgetown University, Joerg Hermann, Mayo
Clinic, Monika Leja, Frankel Cardiovascular Center, Anita Deswal, Baylor College of Medicine, Michael Fradley, Penn Medicine, Jennifer
E. Liu, Memorial Sloan Kettering Hospital, Diego Sadler, Cleveland Clinic Florida, AartiAsnani, Beth Israel Deaconess Medical Center,
Lauren A. Baldassarre, Yale School of Medicine, Dipti, Memorial Sloan Kettering Hospital, EricYang, Los Angeles Medical Center, Avirup
Guha, Augusta University, Sherry-Ann Brown, Froedtert & the Medical College of Wisconsin, Jennifer Stevens, Beth Israel Deaconess
Medical Center, Salim S. Hayek, University of Michigan Health, Charles Porter, The Kansas University Medical Center, Ankur Kalra, Indiana
University, Suzanne J. Baron, Lahey Hospital & Medical Center, Bonnie Ky, Penn Medicine, Salim S. Virani, Baylor College of Medicine,
Dhruv Kazi, Beth Israel Deaconess Medical Center, Khurram Nasir, Houston Methodist Hospital, Anju Nohria, Brigham and Women’s
Hospital, Sarju Ganatra, Lahey Hospital & Medical Center

Social Vulnerability Index and Cardio-oncology Related Mortality Among US Counties 2015-2019
Submission ID 1307129
Background
The present study aimed at studying the impact of social vulnerability index (SVI) of US counties on cardio-
oncology related mortality.
Method
We utilized the Centers for Disease Control and Prevention (CDC) Wide-Ranging Online Data for Epidemiologic
Research (WONDER) multiple cause of death database 2015-2019, to obtain U.S. county-level mortality
and population estimates. We defined mortality secondary to cardiovascular disease using ICD-10 codes
I00-I78 and malignant neoplasms using ICD-10 codes C00-C97. We used the 2018 SVI dataset from CDC’s
Agency for Toxic Substances and Disease Registry to stratify US counties into quartiles with the lowest quartile
representing lowest vulnerability and high quartile representing highest vulnerability. We estimated county-
level age-adjusted mortality rates (AAMRs) per 100,000 person-years with 95% confidence intervals (CIs) for
cancer, CVD, and concomitant cancer and CVD for the overall population and stratified by demographic
variables (age, sex, race, ethnicity) and urbanization. We applied direct age adjustments to crude mortality
rates using the 2000 U.S. population. All analysis was carried out using R version 4.0.3.
Results
Morality secondary to cancer [highest in the 4th quartile (174.09 [173.70 - 174.49] per 100,000 PY) and lowest
in the 1st quartile (160.11 [159.69 - 160.52] per 100,000 PY)] , cardiovascular disease[ highest in the 4th
quartile (443.13 [442.49-443.77] per 100,000 PY) and lowest in the 1st quartile (344.25 [343.63-344.86] per
100,000 PY)] and comorbid cancer and cardiovascular disease[ highest in the 4th SVI quartile (58.25 [58.02-
58.48] per 100,000 PY) and lowest in the 1st SVI quartile (43.47 [43.25-43.69] per 100,000 PY)] was highest in
counties belonging to the 4th quartile of the SVI. Similar trend was noted across demographic variables and
urbanization.
Conclusion
Our study demonstrated a higher comorbid cancer and cardiovascular mortality with higher SVI. The result
emphasizes the need for targeted public health interventions and resource allocation.
Global Cardio-Oncology Summit 2022 Poster Abstracts
P6
Authors
Aneesah Bashir Binti Azad Bashir, University of Glasgow

Cardiovascular Toxicity Associated with BRAF and MEK Inhibitors: A Case Report
Submission ID 1275028
Background
Melanoma rates have been rising rapidly over the past few decades. This had led to the emergence of rapidly
accelerated fibrosarcoma B-type (BRAF) and mitogen-activated extracellular signal-regulated kinase (MEK)
inhibitor combination therapy. However, there has been evidence of unanticipated cardiovascular toxicity
associated BRAF and MEK inhibitors.
Method
A 76-year-old woman presented with stage 3c melanoma which has been resected and for which she was
initiated on treatment with dabrafenib (BRAF inhibitor) and trametinib (MEK inhibitor). She complained of
slight breathlessness and fatigue alongside occasional palpitations when lying down. The patient underwent
a computerised tomography (CT) scan which revealed significant coronary calcification. She was then
diagnosed with severe left ventricular systolic dysfunction (LVSD) post an echocardiogram. The patient has
several underlying cardiovascular risk factors including hypertension and underlying coronary artery disease.
She was prescribed digoxin, sacubitril and dapagliflozin. Furosemide dose was increased to manage her fluid
overload. Patient is stable and is being reviewed on a regular basis.
Results
The exact mechanism of BRAF and MEK inhibitor-induced cardiotoxicity has not been fully understood yet.
Cardiac toxicity of these inhibitors could be linked to few mechanisms including the disturbance of the renin-
angiotensin system (RAS) regulation and the reduced bioavailability of nitric oxide. The decision of continuing
or stopping treatment post a cardiovascular adverse event depends on the extent of cardiotoxicity as well as
the cancer prognosis. In the event of BRAF and MEK inhibitor- associated LVSD as seen in this case, clinicians
should consider temporarily withholding the MEK inhibitor either with or without making changes to the
BRAF inhibitor. Cardioprotective therapies should also be commenced. Essentially, these patients must be
actively monitored to ensure prompt treatment of the associated adverse effects.
Conclusion
_______________________________________________________________________________________

P7
Authors
Priya Arivalagan, University Health Network, Diego Delgado, University Health Network

Case Report
Submission ID 1293609
Background
Transthyretin amyloidosis (ATTR) results from the deposition of transthyretin protein in various organs and
tissues, especially the heart and nerves. This is a case report of a patient with hereditary ATTR, hATTR, that has
cardiac and neurological symptoms (mixed phenotype). This patient was treated with a TTR silencer, Patisiran,
and has demonstrated significant imaging improvement.
Method
A 68-year-old male with hATTR (variant Thr80Ala) was referred to our Amyloidosis Clinic on May
2018. He had a family history of amyloidosis. He presented heart failure symptoms including
dyspnea and fatigue. His echocardiogram showed preserved left ventricular (LV) function with severe
concentric LV hypertrophy. He also presented bilateral carpel tunnel syndrome and hand tremors.
As a result, he underwent a 99Tc-PYP scintigraphy which show a PYP ratio
of 1.76 and a PYP grade of 3, confirming the presence of TTR amyloidosis.
Due to the presence of a mixed phenotype, the decision was to treat him with Patisiran. He received a
total of 3 doses, in which each dose was given every 3 months. His cardiac and neurological symptoms
stabilized after 3 months on treatment. His one-year post treatment echocardiogram was unchanged.
A repeat 99Tc-PYP scintigraphy one year post treatment showed a significant improvement in the PYP grade
to 1.
Results
This is a case of a 68-year-old male patient who demonstrated a significant improvement in the results of
his 99Tc-PYP scintigraphy after receiving the TTR silencer, Patisiran. At the time of his diagnosis, he had the
highest PYP grade indicating significant amyloid deposits, whereas post-treatment, his PYP grade reduced
significantly indicating mild amyloid deposition. His cardiac and neurological symptoms stabilized over the
course of the treatment. This case portrays the benefit of receiving TTR silencers in hATTR patients with mixed
phenotypes.
_______________________________________________________________________________________

P8
Authors
Rodrigo Carrasco, University Health Network, Ted Rogers Centre for Heart Research, University of Toronto, Fernando Rivera Theurel,
University Health Network/Ted Rogers Centre for Heart Research, Henry Su, University Health Network/Ted Rogers Centre for Heart
Research, Husam Abdel-Qadir, Women’s College Hospital, Paaladinesh Thavendiranathan, Toronto General Hospital Research Institute
(TGHRI)

Update on Cardiovascular Effects of New Cancer Immunotherapies: A Systematic Review of CAR-T Cell,
BiTEs and TILs
Submission ID 1311442
Background
Cancer immunotherapy with chimeric antigen receptor T-cells (CAR-T), tumor-infiltrating lymphocyte (TILs)
therapy, or bispecific T-cell engagers (BiTEs), has promising effects on cancer outcomes. However, they are
associated with cardiovascular events and adverse hemodynamic effects, which have a frequency that remains
not fully determined. Objectives. To evaluate the cardiovascular effects of CAR-T, TILs and BiTEs in adult
cancer patients.
Method
We conducted a systematic review of PUBMED, MEDLINE, and EMBASE datasets, supplemented with
a manual search, for clinical studies (prospective and retrospective) or registries of CAR-T, TILs or BiTEs,
which reported any cardiovascular events (cardiac mortality, heart failure, shock/vasopressor use, arrhythmia,
hypertension, other) or hemodynamic effects (sinus tachycardia and arterial hypotension). We assessed the
cardiovascular events and hemodynamic effects of CAR-T, BiTEs, and TILs and meta-regression analysis to
determine their potential association with cytokine release syndrome (CRS).
Results
We identified 39 articles for inclusion in this study: 24 studies plus FAERS registry in CAR-T (4371 patients),
8 BiTEs studies (812 patients), and 6 TILs studies (187 patients). Within clinical studies, cardiovascular events
were reported more frequently with CAR-T (19.3%) and TILs (19.8%) than BiTEs (14.5%) (p< 0.05). CRS was
reported more frequently with CAR-T (65.7%) than BiTEs (10.2%) or TILs (0%) (p< 0.001), as was more severe
CRS (CRS ≥3 - 10.3%, 3.0%, and 0% respectively p< 0.001). For CAR-T, cardiovascular events and CRS rates
were higher in clinical studies than in the FAERS database (p< 0.001). Arrhythmias were the most frequent
cardiovascular event in CAR-T (26.1%) and BiTEs (50.9%), and shock/vasopressors use was in TILs (37.8%).
Hemodynamic effects were reported less frequently in BiTEs than in CAR-T and TILs (p< 0.001). There was no
significant association between rates of CRS and cardiovascular events on meta-regression analysis.
Conclusion
Cardiovascular and hemodynamic adverse effects were frequently reported with new cancer immunotherapies,
with a higher frequency in CAR-T and TILs than BiTEs.
_______________________________________________________________________________________

P9
Authors
Xi Chen, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Lin Li,
Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences

Oxaliplatin-Induced Third-Degree Atrioventricular Block: First Discovery of an Important Side-Effect

Submission ID 1300000
Background
The adverse effects of anticancer therapy in patients with malignancies and cardiovascular diseases are
complicated. Oxaliplatin is one of the most commonly used chemotherapy drugs for gastric and colorectal
cancers, and oxaliplatin-induced cardiotoxicity has rarely been reported.
Method
In the present case, a 76-year-old patient with adenocarcinoma of the esophagogastric junction underwent
cancer therapy and suffered from acute non-ST segment elevation myocardial infarction before surgery.
Because he was unable to undergo surgery or radiotherapy, we implemented tailored chemotherapy with
oxaliplatin and tegafur/gimeracil/oteracil. Unexpectedly, he developed a third-degree atrioventricular block
during oxaliplatin infusion, with newly elevated troponin levels. Having suspected coronary spasms triggered
by oxaliplatin, we administered diltiazem to prevent future onsets and implanted a permanent pacemaker. The
patient reported no discomfort during future chemotherapies, and the pacemaker programming detected no
third-degree atrioventricular blocks.
Results
We used the Naranjo adverse drug reaction probability scale to evaluate the relationship between
chemotherapeutic drugs and arrhythmia in this patient. We calculated the sum of scores as 5, which meant
that oxaliplatin likely caused the arrhythmia. Because prior coronary angiography ruled out the possibility of
acute coronary occlusion, the most likely etiology of the spontaneously resolved third-degree atrioventricular
block and mildly elevated troponin was coronary artery spasm. Certain chemotherapeutics, especially
5-fluorouracil, have been documented to cause myocardial ischemia by inducing coronary arterial spasms.
We found a total of three cases of oxaliplatin-induced coronary spasms through the literature review. This is
the first reported oxaliplatin-induced third-degree atrioventricular block. Remarkably, even the most common
chemotherapy drugs can cause life-threatening cardiac adverse events.
Conclusion
_______________________________________________________________________________________

P 10
Authors
Anita Medepalli, Mercer University School of Medicine, Thomas Bagwell, Mercer University School of Medicine, Lalitha Medepalli, NCVI
Northside Cardiovascular Institutete, Cheryl Jones, Georgia Cancer Specialists, Christina Berry, Department of Medical Oncology at
Northside Hospital, Cindy Wilson, Northside Hospital

Development of a Cardio-Oncology Task Force at a Large Community Health System Anita M. Medepalli,
Thomas W. Bagwell, Lalitha C. Medepalli, Cheryl F. Jones, Christina M. Berry, Cindy Wilson
Submission ID 1301294
Background
Cardio-toxicity is the 2nd most common cause of morbidity and mortality among cancer survivors. Northside’s
analytic case volume is greater than 13,000 per year. Since Northside has achieved a cancer program scale
and cancer case volume that outperforms the vast majority of other nationally-recognized cancer programs, it
created a Cardio-Oncology (CO) task force. The CO task force involves an alliance of oncologists, cardiologists,
pharmacists, researchers, and support service providers. The mission of the task force is to create a program
that supports the early identification of disease, management, and follow-up of oncology patients at risk for
cardiovascular manifestation related to their cancer treatments. This should facilitate cancer treatment while
minimizing cardiotoxicity cardiovascular risks in cancer survivors.
Method
To assess the need for a bridge between cardiology and oncology, an electronic questionnaire survey was
sent to 5 groups of medical oncologists in the Northside system. The survey was designed to identify the
oncologists’ confidence in identifying the risk and management of heart disease caused by their prescribed
therapies. Only 4% of respondents rated their knowledge to be “Very High.” The questionnaire supported
the hypothesis that a bridge between the cardiology and oncology programs at Northside was needed,
leading to the creation of the task force.
Results
The task force has developed new algorithms for cardiovascular risk assessment for patients receiving
medications at the highest risk for future cardiac complications: anthracyclines, HER-2 positive targeted
therapy, Cardio-Oncology ECHO-cardiogram, Immune checkpoint inhibitor, VEGF Inhibitor, and Hypertension
monitoring during cancer treatment. Also, the task force standardized a cardio-oncology echocardiogram
report, increased referral of physicians, consolidated and simplified treatment guidelines, created a CO Nurse
Navigator position, and educated physicians and survivors on the importance of future health outcomes.
The next steps are to re-administer the same survey at Northside to assess the effectiveness of the task force
and to expand the task force into a community CO program that works towards achieving the IC-OS Centers
of Excellence Certification and continues to conduct future research initiatives.
Conclusion
P 11
Authors
Khan Mohammad, Dell Medical School at The University of Texas at Austin, Hanna Fanous, Dell Medical School at The University of Texas
at Austin, Yan Liu, Ascension Texas Cardiovascular

Recurrent Right Ventricular Myocarditis Induced by Immune Checkpoint Inhibitor Despite Therapy
Cessation and Immune Suppression
Submission ID 1304489
Background
A 32-year-old female with a past medical history of type 2 diabetes mellitus and triple negative left sided breast
cancer status post four cycles of carboplatin/paclitaxel and four cycles of doxorubicin and cyclophosphamide
treatment, presented for cardio-oncology evaluation for chest pain 6 weeks after starting Pembrolizumab.
Method
She was found to have new atrial fibrillation, and right ventricle (RV) thrombus on echocardiogram. Her
left ventricular ejection function (LVEF) was found to be reduced at 40%. An invasive coronary angiogram
showed normal coronary arteries, and cardiac magnetic resonance imaging (CMR) revealed myocarditis
predominantly involving the right ventricle with chamber dilation and severe dysfunction. Pembrolizumab
was stopped and the patient was started on high dose steroid therapy for immune checkpoint inhibitor (ICI)
induced myocarditis. She was no longer deemed a candidate for ICI treatment. Her symptoms subsided with
the above intervention with normalization of LVEF to 51% two months after initial presentation. However, three
months after initial presentation, the patient was hospitalized for diabetic ketoacidosis and decompensated
right heart failure. A repeat CMR showed recurrent and active right ventricular myocardial inflammation/
edema without LV involvement. She was once again started on a high dose prednisone taper and diuresed.
She underwent a right heart catheterization afterwards that showed normal filling pressures without evidence
of pulmonary hypertension. At subsequent three month follow up, a surveillance CMR after steroid taper
again showed persistent/recurrent active RV myocarditis without LV involvement. She was therefore started on
chronic immunosuppression with steroids and remains compensated from the right heart failure standpoint.
We report the first documented recurrent, ICI induced myocarditis limited only to RV despite ICI treatment
cessation and immunosuppressive therapy.
Results
This case highlights the fact that isolated, recurrent, severe RV myocarditis with RV failure may occur despite
appropriate treatment, and the importance of regular surveillance with clinical and biomarker evaluation,
and CMR after initial occurrence of ICI induced myocarditis to determine the potential need of chronic
immunosuppression even without ICI re-exposure.
_______________________________________________________________________________________

P 12
Authors
Livia Fu, Hamilton Health Sciences - Juravinski Hospital, Filipe Cirne, McMaster University, Michelle Lui, Hamilton Health Sciences Centre,
Nazanin Aghel, McMaster University, Darryl Leong, McMaster University

Nivolumab-associated Myocarditis with Unusual Presentations

Submission ID 1304723
Background
Myocarditis is a potentially lethal complication of immune checkpoint inhibitor (ICI) use. We present 2 unique
cases of nivolumab-associated myocarditis that highlight the diverse ways in which this complication may
present.
Method
CASE 1
A 61-year-old male with stage IV melanoma with no cardiac risk factors developed stomatitis, dyspnea and
palpitations 28 days after his fourth cycle of nivolumab. Electrocardiogram (ECG) showed sinus tachycardia
and a new right bundle branch block (RBBB). Initial HS troponin I was 17 ng/L (reference range, < 35ng/L) and
remained negative over time. A transthoracic echocardiogram (ECHO) demonstrated new left ventricular (LV)
dysfunction with an ejection fraction of 35% and basal inferior akinesis. Due to findings of new LV dysfunction
and heart failure, he was referred for an endomyocardial biopsy that showed myocarditis. He was successfully
treated with high-dose methylprednisolone followed by a prednisone taper.

CASE 2
A 79-year-old male with stage IIIC melanoma of the left arm and status post wide local excision developed
generalized weakness, dyspnea, dysphagia and ptosis 23 days after his first cycle of nivolumab. ECG showed
sinus rhythm with a new RBBB. Initial CK was 637 u/L (reference range, 40-200 u/L) and HS troponin I was
313 ng/L. Cardiac MRI was consistent with myocarditis. The muscle weakness and ptosis prompted an
electromyography that showed myositis. He was successfully treated with high-dose methylprednisolone,
intravenous immunoglobulins and a prednisone taper thereafter.
Results
ICI-induced myocarditis can present in diverse ways such as with normal troponin levels, new LV dysfunction
or with concurrent irAEs. Given its high mortality rates and clinical benefit with prompt administration of high
dose corticosteroids, ICI induced myocarditis should remain high on the differential diagnosis of patients
with new cardiac symptoms and other irAEs. In which case, additional testing with cardiac MRI and/or
endomyocardial biopsy should be pursued.
_______________________________________________________________________________________

P 13
Authors
Eduardo Schlabendorff, Hospital Mãe de Deus, Vanessa Santos, Hospital Mãe de Deus, Diego Cawen, Hospital Mãe de Deus, Euler
Manenti, Hospital Mãe de Deus

Tumor Thrombus Ascending Through the Inferior Vena Cava and Extending into the Right Atrium
Successfully Removed by a Multidisciplinary Surgical Team in a Young Patient with Advanced Testicular
Cancer
Submission ID 1304997
Background
Tumor thrombus is a rare complication of testis cancer and needs appropriate treatment including
chemotherapy and surgery.
Method
A 23-year-old man was hospitalized in October 2019 with epigastric pain, dyspnea, tachycardia and tachypnea
without hypoxemia. The EKG showed a S1Q3T3 pattern. Laboratory revealed mild anemia, leukocytosis,
normal troponin and BNP levels. D-dimer levels were extremely high. Point-of-care echocardiogram followed
by a 3d echocardiogram showed a large mobile mass compatible with a thrombus inside the right atrium
that incursed towards the right ventricle in diastole. CT angiography revealed a probable tumor thrombus
originated in the left renal vein, entering the inferior vena cava and ascending into the right atrium. There
is also an increase in volume of the left testis and a voluminous expansive mass next to the left renal hilum
most likely associated with lymph node conglomerate. Anticoagulation was started even though CT scan
was inconclusive for pulmonary embolism. The next day, the patient presented clinical worsening with
signs of low output. Due to the high chance of response with cytotoxic chemotherapy in testicular tumors,
chemotherapy with Bleomycin, Etoposide and Cisplatin (BEP) was guided by the oncologist. The patient
underwent a left radical orchiectomy. After 4 courses of BEP chemotherapy the tumor markers normalized. A
surgical team composed of cardiovascular, urological and oncological surgeons performed a triple surgery at
the same surgical moment to remove the tumor thrombus using extracorporeal circulation (figure above). It
was also performed left nephrectomy and retroperitoneal and pelvic lymphadenectomy. Advanced testicular
cancer was diagnosed with a clinical stage of pT2-Nx-MO-S3, which has a poor prognosis. The pathological
examination revealed a mature teratoma. The patient has been disease-free since surgery.
Results
A multidisciplinary approach is necessary to treat patients with tumor thrombus secondary to advanced
testicular cancer.
_______________________________________________________________________________________

P 14
Authors
Taha Ahmed, University of Kentucky, Xiangkun Cao, University of Kentucky, Amit Arbune, Gill Heart & Vascular Institute, University of
Kentucky

Immune Checkpoint Inhibitor Related Myocarditis Masquerading as Acute Coronary Syndrome

Submission ID 1311355
Background
Immune checkpoint inhibitors (ICI) are revolutionary in the armamentarium for cancer management. ICI-
related myocarditis has however, a very high mortality.
Method
64-year-old female with urothelial tract carcinoma, high grade endometrial carcinoma and pancreatic
adenocarcinoma, pulmonary embolism (PE) 1 year prior presented to local ED with syncope and fall. Her current
chemotherapeutic regimen included pembrolizumab every 42 days, initiated 1 year ago. She was
transferred to our center given her complicated history. EKG was unremarkable but hsTnT was remarkably
elevated. CT Chest revealed new thrombus in right pulmonary arteries. A TTE did not show right heart strain
but new LV regional wall motion abnormalities (RWMAs) in several myocardial segments with EF of 38%. Heparin
infusion was initiated for PE. With concerns for ACS, appropriate medical therapy was initiated and a coronary
angiogram planned. However, after evaluation by cardio-oncology, cardiac magnetic resonance (CMR) was
performed. CMR demonstrated a focal area of mid-myocardial late gadolinium enhancement (LGE) in the
basal anteroseptal territory with grossly normal right ventricular function. She was diagnosed with ICI-related
myocarditis per the modified Lake Louise Criteria and high dose steroids were initiated.
Results
Our patient is a moderate-severe case of ICI related myocarditis with decompensated heart failure,
biomarker elevation and imaging evidence of reduced LVEF and LGE suggestive of myocarditis, which based
on 2018 update, includes main criteria of myocardial edema on T2 mapping and non-ischemic myocardial
injury (abnormal T1, ECV, or LGE). Supportive criteria include pericarditis or systolic LV dysfunction. An
initial presentation with worsening PE and concern for ACS in our patient delayed the diagnosis of ICI-
related myocarditis and prompt treatment. The importance of this case gets highlighted where concerns
for more common causes of new onset heart failure in an oncologic patient could delay diagnosis of rarer
cardiomyopathies.  CMR holds  importance  in ICI-related myocarditis with high sensitivity and specificity to
assess LV/RV function, RWMAs, myocardial edema, LGE and ECV quantification. High-dose steroids remain
the mainstay management while immunomodulators are currently under investigation.
_______________________________________________________________________________________

P 15
Authors
Boda Zhou, Beijing Tsinghua Changgung Hospital, Ping Zhang, Beijing Tsinghua Changgung Hospital

Two Death Cases After Immune Checkpoint Inhibitor Therapy and Case Review
Submission ID 1301198
Background
A 51 year old male patient, who suffered from recurrence of liver cancer after surgery. After ablation, he received
targeted therapy combined with immunotherapy. The first PD-1 monoclonal antibody infusion was performed
on October 10, 2020, and the seventh PD-1 injection was prepared. Routine reexamination found that TNT
increased, accompanied by hoarseness, toothache, headache, and no obvious fatigue, chest tightness, chest
pain, and dyspnea. He came to our Cardio-Oncology clinic for further examination (February 18, 2021).
Echocardiography found no abnormality, the left ventricular ejection fraction is 64%.
PD-1 inhibitor was stopped, methylprednisolone 80mg intravenous infusion was given once, and metoprolol
40mg QD was taken orally, supplemented with trimetazidine, potassium and calcium. The patient had no
obvious symptoms. After 5 days, he died suddenly at home and was sent to our hospital. Serum Troponin
was normal.
Method
A 52 year old male with abdominal metastasis of liver cancer was diagnosed with fatigue and fatigue after 2
months of targeted therapy combined with immunotherapy (October 10, 2019). The first PD-1 monoclonal
antibody infusion was performed on August 10, 2019, and the third injection of PD-1 was prepared. The
routine reexamination found that serum TNT increased, with troponin T 5.923 ↑ ng/ml, myoglobin 2756.29 ↑
ng/ml, and creatine kinase isoenzyme MB 146.42 ↑ ng/ml. The patient was admitted to our Cardio-Oncology
ward at 11:10 October 10, 2019. Unfortunately, the patient died at 16:57 October 10, 2019 because of
ventricular fibrillation, electric defibrillation was given for 2 times, but the spontaneous circulation was not
restored.
Results
The diagnostic criteria of ICI related myocarditis are complex, and the risk increases while waiting for diagnosis.
The fatal arrhythmia caused by ICI related myocarditis needs great importance and ECG monitoring needs
to be strengthened.
_______________________________________________________________________________________

P 16
Authors
Muhummad Sohaib Nazir, Royal Brompton Hospital, Jenny Thomas, Royal Marsden Hospital, Vicki Chambers, Royal Brompton Hospital,
Sivatharshini Ramalingham, Royal Brompton Hospital, Theodore Murphy, Royal Brompton Hospital, Nana Poku, Royal Brompton Hospital,
Stuart Rosen, Royal Brompton Hospital, Alexander Lyon, Royal Brompton Hospital
Metastatic Melanoma Therapy Complicated by Structural and Electrical Heart Disease: Between a Rock
and a Hard Place
Submission ID 1304549
Background
A 75 year old male was referred to the cardio-oncology services for metastatic melanoma. He had previously
underwent two cycles of ipimimumab/nivolumab which was unfortunately complicated by checkpoint inhibitor
(CPI) induced colitis which required steroid therapy and infliximab. He had further disease progression and
therefore the oncology team initiated him on dual tyosine kinase inibitor (TKI) therapy with Dabrafenib and
Trametenib. His baseline LV systolic function at his point was recorded as an LVEF 49%. His cardiovascular
risk factors included hypertension and hypercholesterolaemia. He was also known to have atrial fibrillation for
which he was anticoagulated with warfarin.
Method
Following initiation of Dabrafenib and Trametenib the LV systolic continued to progressively
decline to LVEF 36%. He was initiated on bisoprolol and ramipril with the aim to uptitrate to
optimal therapy. A 24 hour EKG monitor demonstrated atrial fibrillation with a significant amount
of ventricular ectopy (24%). A cardiac MRI was arranged with confirmed impaired LV systolic
function, no inflammation, and transmural myocardial infarction in the basal inferoseptum.
We attempted to arrange for urgent admission to the cardiac centre for urgent optimisation but was
complicated by i) mechanical fall ii) acute ischaemic limb and iii) COVID-19 infection. Ultimately he underwent
coronary angiography which demonstrated only mild coronary atheroma. He was discussed at the MDT
with electrophysiologists who initiated amiodarone and mexilitine to suppress ectopy. He was uptitrated on
maximally tolerated prognostic heart failure medications, which had to be carefully balanced with peripheral
vascular disease, renal function and blood pressure.
Results
CPI and dual TKI is associated with adverse cardiovascular effects. In this patient, a multitude of
extra-cardiac complications occurred which made his management quite challenging. He required
close multidisciplinary care with oncologists, vascular surgeons, cardio-oncologists, cardiologists
with electrophysiology expertise, imagers and specialist heart failure nurses. Care and expertise
in specialist centres with the facilities and infrastructure are required to manage these often
complex patients, in which clinical decision making needs to be undertaken on a timely basis. 
_______________________________________________________________________________________

P 17
Authors
Yanjun Zhou, Chinese Academy of Medical Sciences / Peking Union Medical College, Qiuyue Li, Chinese Academy of Medical Sciences
/ Peking Union Medical College, Haojie Yang, Chinese Academy of Medical Sciences / Peking Union Medical College, Yule Hu, Chinese
Academy of Medical Sciences / Peking Union Medical College, Tao Liang, Chinese Academy of Medical Sciences / Peking Union Medical
College

Analysis of the Incidence Rate and Influencing Factors of Anthracycline Chemotherapy-related Acute
Cardiotoxicity in Chinese Patients of HER2+ Breast Cancer: A Retrospective Study
Submission ID 1276423
Background
The chemotherapy regimen containing anthracyclines is recommended as the standard chemotherapy regimen
for HER2 positive breast cancer patients. However, it is easy to cause cardiotoxicity (ACT) when used. Act will
cause varying degrees of damage to the heart, limit the choice of effective treatment options, affect the
treatment process and survival prognosis of tumor patients, increase the economic burden, and even cause
the death of patients, offsetting the survival benefits brought by chemotherapy. There is growing interest in
the impact of cardiovascular disease on cancer survivors. However, contemporary population-based data on
the risk of cardiovascular death after HER2 positive breast cancer are limited.
Method
A retrospective study was conducted to collect the information of 320 HER2 positive breast cancer patients who
received anthracycline chemotherapy. According to the occurrence of acute cardiotoxicity, they were divided
into non cardiotoxicity group and cardiotoxicity group. Logistic regression was used to analyze the age, body
mass index, tumor stage, previous disease history, combined radiotherapy, combined chemotherapy drugs
and other factors of the two groups, so as to reveal the influencing factors of acute cardiotoxicity.
Results
Among 320 patients with breast cancer who received epirubicin chemotherapy, 135 had cardiotoxicity, the
incidence rate was 42.19%. History of hypertension, history of hyperlipidemia, BMI, combination of trastuzumab
and non combination of dexamethasone were independent risk factors for cardiotoxicity.
Conclusion
The incidence of acute cardiotoxicity in patients with HER2 positive breast cancer after anthracycline
chemotherapy is high. For patients with a history of hypertension, hyperlipidemia, high BMI and treated with
trastuzumab, we should strengthen monitoring, actively control the blood pressure and blood lipid level of
patients, and use dexamethasone in combination to avoid cardiotoxicity.
_______________________________________________________________________________________

P 18
Authors
Martín Ruiz Ortiz, Reina Sofía University Hospital., Alberto Piserra López-Fernández de Heredia, Reina Sofía University Hospital, Arancha
Díaz Expósito, Virgen de la Victoria University Hospital., Alejandro Pérez Cabeza, Virgen de la Victoria University Hospital., Javier Torres
Llergo, Jaen University Hospital, Marinela Chaparro Muñoz, Virgen Macarena University Hospital, José Javier Sánchez Fernández, Puerta
del Mar University Hospital, Dolores Mesa Rubio, Reina Sofía University Hospital

Major Cardiovascular Events in Patients with Atrial Fibrillation and Active Lung Cancer: “real World”
Data from the CANAC-FA Registry
Submission ID 1285867
Background
Our aim was to describe the incidence of major cardiovascular events in patients with atrial fibrillation (AF) and
active lung cancer from daily clinical practice.
Method
We used data from CANAC-FA Registry, an observational, multicentre, retrospective study. The medical
records of all subjects attended at the outpatient oncology clinics attending lung cancer patients from January
1st, 2017 to December 31st, 2019 in five tertiary university hospitals in Spain were reviewed. The first visit
with previous or present AF diagnosis during the first year after lung cancer diagnosis was considered the
basal visit. End points were stroke/systemic embolism, thrombotic events, major bleeding, and cardiovascular
events. Death without the event of interest was considered a competing risk.
Results
Among 6984 patients, 269 presented active lung cancer and AF (3.9%). Mean age was 71±8 years, and 91%
were male. Cardiovascular risk factors were: hypertension 78%, dyslipidemia 50%, diabetes 37% and active
smoking 30% (62% ex-smokers). Charlson, CHA2DS2VASc and HAS-BLED indexes were 6.6±2.9, 3.0±1.4
y 2.4±1.2, respectively. Tumor stage was I, II, III and IV in 13%, 9%, 24% and 54% of the study sample,
respectively. Anticoagulants were prescribed to 84% of the patients: direct anticoagulants (43%), low molecular
weight heparins (30%) and vitamin K antagonists (26%). After up to 46 months of follow-up, 186 patients died.
Cumulative incidences of major events at 1, 2 and 3 years of follow-up were 2.4±1.0%, 3.3±1.3% y 3.3±1.3%
for stroke/systemic embolism (n=7); 4.7±1.3%, 8.4±2.1% y 8.4±2.1% for thrombotic events (n=18); 2.7±1.0%,
6.7±1.9% and 9.9±2.6% for major bleeding (n=16), and 9.9±1.9%, 13.8±2,5% y 15.3±2,9% for cardiovascular
events (n=34).
Conclusion
Cumulative incidence of cardiovascular events was 15% at 3 years in this “real world” population of patients
with active lung cancer and AF. These data could suggest an unmet need for more effective preventive
strategies in this population.
_______________________________________________________________________________________

P 19
Authors
Martín Ruiz Ortiz, Reina Sofía University Hospital., Inmaculada Fernández Valenzuela, Virgen Macarena University Hospital, Arancha
Díaz Expósito, Virgen de la Victoria University Hospital., Marinela Chaparro Muñoz, Virgen Macarena University Hospital, Ana Rodríguez
Almodóvar, Reina Sofía University Hospital, Magdalena Carrillo Bailén, Jaen University Hospital, Inara Alarcón de la Lastra Cubiles, Puerta
del Mar University Hospital, José Javier Sánchez Fernández, Puerta del Mar University Hospital

Factors Associated with No Anticoagulation in Patients with Atrial Fibrillation, Active Lung Cancer and
High Thromboembolic Risk: Data from the CANAC-FA Registry
Submission ID 1286067
Background
Our aim was to investigate the factors associated with no anticoagulation prescription in patients with active
lung cancer, atrial fibrillation (AF) and high thromboembolic risk.
Method
Data from an observational, multicentre, retrospective study were used. Patients with active lung cancer (<
1 year of diagnosis) and AF attended from 2017 to 2019 in five tertiary university hospitals in Spain were
selected. Thromboembolic risk was evaluated by the CHA2DS2VASc score (0 low risk, 1, intermediate and
≥2, high risk for males; and 1, 2 and ≥3 for females) and variables associated with no anticoagulation in high
risk patients were investigated.
Results
Among 6984 patients visited at outpatient oncology clinics attending lung cancer patients, 269 presented
active lung cancer and AF (3.9%). Anticoagulation was prescribed to 4/11 patients (36%), 33/41 patients
(80%) and 191/217 patients (88%) with low, intermediate and high thromboembolic risk (p< 0.0005). In high
risk patients, no prescription of anticoagulants (n=26, 12%) was significantly associated with peripheral artery
disease, lower Charlson index, non-permanent AF, cardiomyopathy, absence of previous anticoagulation and
prior antiplatelet treatment (p< 0.05). In multivariate analysis, peripheral artery disease (OR 5.30[1.65-17.04]),
non-permanent AF (OR 4.55[1.53-13.56]), ischemic heart disease (OR 2.88[1.03-8.04]), and lower Charlson
index (OR 0.76[0.60-0.97]) were independently associated with no anticoagulation prescription. After including
treatment variables in the model, no prescription of angiotensin converting enzyme inhibitors (OR 6.9[1.35-
35.20]) and absence of previous anticoagulation (OR 293.16[48.17-1784.06]) emerged as independent
predictors of no anticoagulation (p< 0.05).
Conclusion
In this multicentre contemporary study, anticoagulation prescription was high in patients with active lung
cancer, AF and high embolic risk. Clinical and treatment variables could identify patients at risk of no receiving
this treatment.
_______________________________________________________________________________________

P 20
Authors
Martín Ruiz Ortiz, Reina Sofía University Hospital., Arancha Díaz Expósito, Virgen de la Victoria University Hospital., Inmaculada Fernández
Valenzuela, Virgen Macarena University Hospital, Alejandro Pérez Cabeza, Virgen de la Victoria University Hospital., Fátima Esteban
Martínez, Reina Sofía University Hospital, Javier Torres Llergo, Jaen University Hospital, José Javier Sánchez Fernández, Puerta del Mar
University Hospital, Marinela Chaparro Muñoz, Virgen Macarena University Hospital

Clinical Profile and Outcomes of Anticoagulated Patients with Atrial Fibrillation and Active Lung Cancer
According to the Anticoagulant Drug Type: A “real World” Study
Submission ID 1287056
Background
Our aim was to describe the clinical profile and outcomes of anticoagulated patients with active lung cancer
and atrial fibrillation (AF) according to the anticoagulant drug type
Method
Data from an observational, multicentre, retrospective study were used. Anticoagulated patients with active
lung cancer (< 1 year) and AF attended from 2017 to 2019 in five tertiary university hospitals in Spain were
selected. A comparative analysis was performed according to the anticoagulant drug type prescribed. Death
without events of interest was considered a competing risk.
Results
Among 6984 patients visited at outpatient oncology clinics attending lung cancer patients, 269 presented
active lung cancer and AF (3.9%), and 228 were prescribed anticoagulants: vitamin K antagonists [VKA],
direct oral anticoagulants [DOAC] and low molecular weight heparins [LMWH] to 60, 99 and 69 patients,
respectively. Baseline clinical variables differed significantly among the three groups of treatment (VKA,
DOAC and LMWH, respectively): mean age (74±6, 71±8 and 69±7 years, p=0.001), frequency of renal failure
(GFR< 60 ml/mn/1.73 m2, 28%, 17% and 42%, p=0.002), permanent AF (65%, 44% and 46%, p=0.03), cancer
stage I (18%, 11% and 4%, p=0.04) and chemotherapy treatment (prior: 18%, 30% and 57%, p< 0.0005; and
planned: 43%, 63% and 71%, p=0.005). After up to 46 months of follow-up, probabilities of stroke/systemic
embolism (n=6) at two years were 5.2%, 2.1% and 1.6% (p=0.41); major bleeding (n=12), 0%, 9.0% and 5.2%
(p=0.049); cardiovascular events (n=26), 11.9%, 11.5% and 6.0% (p=0.30); and death (n=154), 58%, 75% and
78% (p=0.01), respectively, for patients treated with VKA, DOAC and LMWH.
Conclusion
In this multicentre, contemporary, “real world” registry, basal features of the patients were different among
those treated with VKA, DOAC or LMWH. We observed lower mortality for those treated with VKA and higher
risk of major bleeding for those treated with DOAC.
_______________________________________________________________________________________

P 21
Authors
Martín Ruiz Ortiz, Reina Sofía University Hospital., Alberto Piserra López-Fernández de Heredia, Reina Sofía University Hospital, Dolores
Mesa Rubio, Reina Sofía University Hospital, Marinela Chaparro Muñoz, Virgen Macarena University Hospital, Inara Alarcón de la Lastra
Cubiles, Puerta del Mar University Hospital, Magdalena Carrillo Bailén, Jaen University Hospital, Javier Torres Llergo, Jaen University
Hospital, Alejandro Pérez Cabeza, Virgen de la Victoria University Hospital

Causes of Death and Predictors of Mortality in Patients with Atrial Fibrillation and Active Lung Cancer:
Insights from the CANAC-FA Registry
Submission ID 1287066
Background
“Real world” data on cardiovascular prognosis of patients with atrial fibrillation (AF) and active lung cancer are
limited. Our aim was to describe causes of death and predictors of mortality in this population
Method
Data from an observational, multicentre, retrospective study were used. Patients with active lung cancer (< 1
year) and AF attended from 2017 to 2019 in five tertiary university hospitals in Spain were selected. Causes
of death were classified as cardiovascular and non-cardiovascular and associated variables were investigated.
Results
Among 6984 patients visited at outpatient oncology clinics attending lung cancer patients, 269 (age 71±8
years, 91% male) presented active lung cancer and AF (3.9%). Tumour stage was III and IV in 34% and 46%
of the study sample. After up to 46 months of follow-up, 186 patients died, 11 from cardiovascular causes.
Probability of survival was 43%, 25% and 15% at 1, 2 and 3 years. Independent predictors of mortality (all
with < 2% missing values) were: anaemia (HR 1.41 [CI95% 1.04-1.92]), tumour stage III-IV (HR 2.30 [CI95%
1.37-3.91]), cardiomyopathy (HR 1.65 [CI95% 1.11-2.45]), surgical cancer treatment (previous HR 0.37 [CI95%
0.20-0.67]; planned HR 0.25 [CI95% 0.07-0.82]), prescription of vitamin K antagonists (HR 0.58 [CI95% 0.39-
0.88]), calcium channel blockers (HR 1.63 [CI95% 1.16-2.29]), ivabradine (HR 6.67 [CI95% 1.58-28.07]), and
antiarrhythmic agents (HR 0.37 [CI95% 0.18-0.75]); an additional model including baseline heart rate (24% of
missing values) showed that hypertension (HR 1.91 [CI95% 1.17-3.12]), smoking in < 1 year (HR 1.88 [CI95%
1.30-2.71]), and heart rate (HR 1.14 [CI95% 1.04-1.24] per 10 bpm) were independently associated with
mortality (p< 0.05 for all).
Conclusion
Conclusions: All-cause mortality in the short-term follow-up was very high in this “real world” study of patients
with active lung cancer and AF. Most of them died from non-cardiovascular causes, and clinical variables could
identify patients at higher risk of death.
_______________________________________________________________________________________

P 22
Authors
Martín Ruiz Ortiz, Reina Sofía University Hospital., Magdalena Carrillo Bailén, Jaen University Hospital, Inara Alarcón de la Lastra Cubiles,
Puerta del Mar University Hospital, Alberto Piserra López-Fernández de Heredia, Reina Sofía University Hospital, Inmaculada Fernández
Valenzuela, Virgen Macarena University Hospital, Arancha Díaz Expósito, Virgen de la Victoria University Hospital., José Javier Sánchez
Fernández, Puerta del Mar University Hospital, Mónica Delgado Ortega, Reina Sofía University Hospital

Clinical Profile and Cardiovascular Prognosis of Patients with Atrial Fibrillation and Active Haematological
Malignancies: “real World” Data from the CANAC-FA Registry
Submission ID 1287071
Background
“Real world” observational data on cardiovascular prognosis of patients with atrial fibrillation (AF) and active
haematological malignancies are very limited. Our aim was to describe the clinical profile and incidence of
major cardiovascular events in this population.
Method
Data from an observational, multicentre, retrospective study were used. Patients with with chronic lymphocytic
leukemia (CLL) or multiple myeloma (MM) with clinical criteria for specific treatment and AF attended from
2017 to 2019 in five tertiary university hospitals in Spain were selected. Major bleeding, cardiovascular events
and mortality were the end-points.
Results
Among 7793 patients visited at outpatient haematology clinics attending CLL or MM, 1189 had AF (15%), and
81 presented active haematological malignancy and AF (1%). Mean age was 75±8 years, and 56% were male.
Cardiovascular risk factors were: hypertension 64%, dyslipidemia 36%, diabetes 36% and active smoking
19% (26% ex-smokers). Charlson, CHA2DS2VASc and HAS-BLED indexes were 5.3±1.7, 3.4±1.5 y 2.4±1.1,
respectively. CLL was present in 33 patients (41%) and MM in 48 (59%). Anticoagulants were prescribed
to 85.2% of the patients: direct anticoagulants (42%), low molecular weight heparin (13.6%) and vitamin K
antagonists (29.6%). After up to 59 months of maximum follow-up, cumulative incidences of major events at
1, 2 and 3 years of follow-up were 1.2±1.2%, 1.2±1.2 and 3.5±2.5% for major bleeding (n=2); 11.6±3.7%,
11.6±3.7 and 17.2±5.3% for cardiovascular events (n=14); and 27.6±5.0%, 41.5±6.3 and 51.3±6.9% for all-
cause death (n=38).
Conclusion
Cumulative incidence of cardiovascular events in follow up was relatively high in this “real world” population
of patients with active haematological malignancies and atrial fibrillation. These data could suggest an unmet
need for more effective preventive strategies in this population.
_______________________________________________________________________________________

P 23
Authors
Priya Arivalagan, University Health Network, Diego Delgado, University Health Network, Rodrigo Carrasco Loza, University Health
Network, Natalia Nugaeva, University Health Network, Faria Fahim, University Health Network

Early Detection of Polyneuropathy in Patients with Hereditary Transthyretin Amyloid Cardiomyopathy

Submission ID 1293600
Background
Patients with hATTR cardiomyopathy (CM), can show early neurological signs which lead to the eventual onset
of neurological symptoms. Early detection of polyneuropathy among patients with hATTR-CM can identify
candidates for new disease modifying therapies that could significantly reduce mortality and morbidity in these
complex patients. The purpose of this study is to examine the role of systematic neurological examinations in
patients with hATTR-CM.
Method
Twenty-eight patients with hATTR-CM who did not have any neurological symptoms were enrolled in this
prospective study from the Amyloidosis Clinic at the University Health Network. All patients (average age
65.71± 14.23 years; 39.3% males; 60.7% females) were referred to a neurology program specialized in
hATTR polyneuropathy (PN). Comprehensive neurological assessments were conducted including a physical
examination and nerve conduction studies (NCS). NCS was performed on the upper and lower extremities.
Results
Twelve (42.9%) patients did not display any neurological abnormalities on the physical examination, but they
had abnormalities on the NCS suggesting the presence of TTR-PN. The abnormalities on the NCS were diffuse
sensory greater than motor polyneuropathy. Ten (35.7%) patients displayed clinical and NCS abnormalities.
Six (21.4%) patients did not display any clinical or NCS abnormalities. Based on the systematic neurological
assessment, twenty-two patients in our study were identified as mixed hATTR phenotype and are to receive
specific disease modifying therapies, either Patisiran or Inotersen.
Conclusion
Patients with hATTR-CM can display a wide range of neurological symptoms. In this study, we were able to
identify a significant number of patients with abnormal neurological tests in the absence of obvious neurologic
signs and symptoms suggesting TTR-PN. Therefore, patients with hATTR-CM should be systematically referred
to a specialised neurologist for routine assessment.
_______________________________________________________________________________________

P 24
Authors
Diego Delgado, University Health Network, Dakota Gustafson, University Health Network, Bennett Di Giovanni, University Health
Network, Julie Vishram-Nielsen, University Health Network, Mitchell Adamson, University Health Network

Elucidating Associations Between Technetium Pyrophosphate Scintigraphy, Echocardiography, and

Cardiac Biomarkers in Transthyretin Cardiac Amyloidosis
Submission ID 1293614
Background
There are various diagnostic tests for amyloidosis which includes imaging modalities (i.e., 99mTc-PYP
scintigraphy, echocardiography, and cardiac magnetic resonance imaging) and the levels of cardiac biomarkers
(troponin I and brain natriuretic peptide [BNP]). However, the associations between these tests are unclear.
Thus, the purpose of this study is to determine the associations between the imaging methods and cardiac
biomarkers.
Method
This study included 183 patients from the Amyloidosis Clinic at the University Health Network. These patients
are at least 18 years of age and have ATTR cardiac amyloidosis. Patients underwent imaging assessment
with echocardiogram and/or cardiac MRI, 99mTc-PYP scintigraphy and biomarkers. Linear regression and
multivariate proportional hazard models were conducted to examine the associations between the imaging
modalities, endomyocardial biopsy, and cardiac biomarkers (i.e., cardiac troponin I and BNP).
Results
Significant associations were determined between PYP grade and two parameters from the echocardiogram,
which are the left ventricular mass and wall thickness. There were also significant associations between PYP
grade and the two cardiac biomarkers. There is no association between the heart-to-contralateral lung ratio
from the PYP scintigraphy with the cardiac biomarkers. However, there is an association between the heart to
contralateral lung ratio and the left ventricular mass.
Conclusion
Overall, we identify various associations between the conventional diagnostic tests. The differing relationships
among the diagnostic methods can be used to determine the diagnosis and staging of amyloidosis. As a
result, understanding the associations between certain tests and applying these associations in a clinical
setting would improve the care for ATTR-CA patients. Therefore, the quality of care for ATTR-CA patients
would be enhanced, since there are various therapeutics that are currently available to them.
________________________________________________________________________________________
P 25
Authors
Yanjun Zhou, Chinese Academy of Medical Sciences / Peking Union Medical College, Qiuyue Li, Chinese Academy of Medical Sciences
/ Peking Union Medical College, Yule Hu, Chinese Academy of Medical Sciences / Peking Union Medical College, Haojie Yang, Chinese
Academy of Medical Sciences / Peking Union Medical College, Fang Zhao, Chinese Academy of Medical Sciences, Tao Liang, Chinese
Academy of Medical Sciences / Peking Union Medical College

Risk Factors of Acute Radiation-induced Cardiac Injury in Patients with Breast Cancer and Establishment
of Predictive Model
Submission ID 1297185
Background
To explore the risk factors of acute heart injury in patients with breast cancer who received radiotherapy after
operation and establish a prediction model, in order to provide a theoretical basis for the prediction, diagnosis
and prevention of such patients.
Method
A total of 136 patients with breast cancer diagnosed by pathological examination from the beginning of
2016 to the end of 2021 were retrospectively analyzed. First, univariate analysis was performed, and then
multivariate logistic analysis was performed on the variables with P < 0.05 to establish the regression model,
and the subject working characteristic curve (ROC curve) was used to evaluate the prediction model.
Results
There were 46 cases of radiation-induced heart injury in 136 patients. The incidence rate of radiation-induced
heart injury was 33.8%. The results of single factor analysis of clinical factors showed that BMI, blood glucose,
blood pressure, blood lipids, TC, TG, HDL-C, HBDH, cardiac Dmax, dmean and cardiac v20-v35 were related
to the occurrence of radiation-induced heart injury. Multivariate analysis showed that blood pressure, blood
lipid, TG, HBDH, heart dmean and V30 were independent factors of radiation-induced heart injury. The area
under the curve (AUC) of ROC was 0.971 (95% CI: 0.927 ~ 10.992, P < 0.001), the cutoff point was 0.8353, the
sensitivity of the model was 91.30%, and the specificity was 92.22%.
Conclusion
Blood pressure, blood lipid, TG, HBDH, heart dmean and V30 after radiotherapy are independent risk factors
of radiation-induced heart injury. Targeted intervention measures should be implemented for key populations.
The establishment of prediction model has a certain value in predicting the occurrence of acute heart injury.
________________________________________________________________________________________

P 26
Authors
Eduardo Zatarain Nicolas, Hospital Gregorio Marañón, Raul Córdoba, Hospital Universitario Fundación Jiménez Díaz, Dolors Colomer,
Hospital Clínic, IDIBAPS, CIBERONC, Carolina Leiva, AstraZeneca Farmacéutica Spain, Esther Álvarez, AstraZeneca Farmacéutica Spain,
María Dolores López, AstraZeneca Farmacéutica Spain, Antoni Bayés-Genís, Hospital Universitari Germans Trias i Pujol

In Silico Evaluation of Mechanisms Behind Ibrutinib- and Acalabrutinib-induced Atrial Fibrillation in

Chronic Lymphocytic Leukemia
Submission ID 1299671
Background
Despite many benefits, ibrutinib (Ibru) is associated with adverse effects of special concern, especially in the
cardiovascular system. Acalabrutinib (Acala), as 2nd generation BTKi with more selective inhibition, has less
off-target side effects; as also supported by a recent head-to-head trial. We present an artificial intelligence-
based in silico study to infer the pharmacological mechanisms underlying atrial fibrillation (AF) induced by
these drugs.
Method
Mechanistic models of Ibru and Acala at the protein interactome level were created using a Therapeutic
Performance Mapping System technology (Anaxomics Biotech). We compiled information to molecularly
characterize AF and both BTKi’s target profile. Then, we applied supervised machine learning algorithms to
computationally infer AF mechanisms. Previously described model-derived measures were used to rank targets
more likely triggering AF. We finally identified potential mechanisms of action of inhibiting these targets.
Results
The results show that BTK inhibition is not the only factor contributing to AF induction, as it could be mediated
by other off-targets impacting pathophysiological processes. Both drugs can modulate common pathways
through their common off-targets TEC and ERBB4, but no specific Acala off-target was identified. However,
Ibru presents specific mechanisms suggesting atrial remodeling (through HCK, FGR, LYN and FLT3 off-targets)
and fibrosis-related processes and electrophysiology regulation (through LYN and SRC off-targets).
Conclusion
According to this model, BTKi-induced AF is an off-target effect, mediated partially by TEC and ERBB4
inhibition. Other Ibru-specific targets and mechanisms could explain its association with higher incidence.
Though potential literature bias and TEC/ERB4 inhibition potency should be considered in prospective studies
to better differentiate Acala and Ibru mechanisms, these results might drive further understanding of the
mechanisms behind their difference in AF incidence to enhance tolerability in CLL patients.
________________________________________________________________________________________

P 27
Authors
Jennifer Jordan, Virginia Commonwealth University, Alexandra Thomas, Atrium Wake Forest Baptist Medical Center, Susan Dent, Duke
Cancer Institute

Cardiac Outcomes with near Complete Estrogen Deprivation in Pre-menopausal Women with Early Stage
Breast Cancer
Submission ID 1299912
Background
An estimated 48,080 (19% of total) of women diagnosed with breast cancer (BC) in the US in 2017 were 49 and
younger; 4.5% were less than 40. Clinical trials have demonstrated that near complete estrogen deprivation
(NCED) in premenopausal women with hormone receptor (HR) positive BC, at high risk for recurrence, improves
the rate of freedom from BC. However, hypoestrogenemia, is independently associated with cardiovascular
(CV) morbidity. This, together with the CV morbidity associated with other aspects of BC treatment, threaten
to offset survival gains seen in BC. The cardiotoxicity of a “dual-hit” from abrupt ovarian function suppression
combined with an aromatase inhibitor (AI) is unknown. The primary aim of this study is to understand the
evolution of CV injury, as well as biomarker and demographic correlates for young women with BC treated with
NCED, with the ultimate goal of developing tools to assess and mitigate CV risk.
Method
Women with stage I-III HR + BC, age ≤55 who were premenopausal at the time of BC diagnosis, treated
with NCED therapy that includes an AI (with medically or surgically induced menopause) following completion
of any planned chemotherapy, surgery and radiation therapy, or within 3 months of initiating treatment with
NCED, are eligible for this study. Women with human epidermal growth factor-2 (HER2) negative or HER2
+ BC are eligible. Patients (pts) may receive a CDK 4/ inhibitor as part of anti-neoplastic treatment and
a selective-estrogen receptor degrader (SERD) rather than an AI. The primary objective of this study is to
determine the 24-month difference in stress myocardial blood flow during adenosine stress cardiovascular
magnetic resonance imaging (CMR) in premenopausal women treated with NCED for high-risk HR + BC. A
secondary objective is to develop predictive models to identify pre-menopausal women with high risk HR +
BC treated with NED who are at highest risk for developing deficits in myocardial blood flow.
Results
This trial is actively recruiting pts at 3 sites in the United States. 90 pts (65 treated with NCED and 25 triple
negative - control) will be recruited over 2.5 years with up to 3 years follow-up.
Conclusion
Is this study, we are evaluating pre-menopausal women with serial CV imaging to more fully understand the
impact of NCED treatment on small and large heart vessels.
________________________________________________________________________________________

P 28
Authors
Amanda Swan, Edinburgh Cancer Centre, NHS Lothian, Peter Henriksen, Department of Cardiology, NHS Lothian, Alan Japp, Department
of Cardiology, NHS Lothian, Frances Yuille, Edinburgh Cancer Centre, NHS Lothian, Peter Hall, Edinburgh Cancer Centre, NHS Lothian

Measurement of Ejection Fraction in Early Breast Cancer Patients Receiving Adjuvant Trastuzumab
Submission ID 1301727
Background
The use of anthracyclines and HER2 targeted agents in breast cancer requires monitoring of ejection fraction.
Historically ejection fraction has been monitored using multiple gated acquisition scanning (MUGA). The use
of ECHO to monitor ejection fraction has multiple potential benefits. It is a cheaper test, routinely available,
without additional radiation exposure. Here we demonstrate changes in ejection fraction over time in those
scanned using ECHO or MUGA since 2015.
Method
Patients starting adjuvant trastuzumab between 01/01/2015 and 01/11/2021 were identified from Chemocare
treatment allocation. Ejection fraction monitoring using ECHO or MUGA was recorded via patient electronic
TRAK records. NHS schedule of costs was used to estimate potential cost savings.
Results
Between September 2013 and November 2021, 54 patients had ejection fraction monitored using
MUGA and 54 patients had ejection fraction monitored using ECHO. As anticipated, there appears to
be a fall in measured ejection fraction with time. In line with clinical guidelines, 5 patients had adjuvant
trastuzumab held due to a fall in measured ejection fraction (2 ECHO, 3 MUGA). 1 patient was unable to
restart treatment. No clinically significant cardiac impairment was missed by moving from MUGA to ECHO.
This potential treatment related cardiac toxicity rate is lower than those quoted in the pivotal papers.

The NHS schedule for costs estimates the price per unit of ECHO to be £87 and MUGA £122.
Cost saving per patient, based on minimum of 4 ejection fraction measurements is £140.

In an adult patient, during each MUGA scan, there are radiation-absorbed doses to the critical organs.
With increasing survival in breast cancer patients, the cumulative exposure to radiation through medical
investigations including MUGA and CT has the potential to be significant.
Conclusion
Monitoring ejection fraction using ECHO in patients receiving HER2 targeted agents is a reliable and safe
procedure with low rates of cardiac toxicity reported in this real life patient cohort. A move from MUGA to
ECHO monitoring has potential cost saving benefits as well as reducing patient exposure to radiation through
routine investigations.
________________________________________________________________________________________

P 29
Authors
Julius Heemelaar, Leiden University Medical Center, Marloes Louwerens, Leiden University Medical Center, Steffie Heemelaar, Leiden
University Medical Center, Svenja Hertel, Leiden University Medical Center, Marieke Sueters, Leiden University Medical Center, Louisa
Antoni, Leiden University Medical Center

Cardiac and Obstetric Outcomes of Pregnancies for Women After Cardiotoxic Therapy in Childhood: A
Single Center Observational Study
Submission ID 1302471
Background
Pregnancy is a challenge for women with childhood exposure to cardiotoxic therapies due
to increased risk of cardiomyopathy and adverse pregnancy outcomes. But there is limited
literature available regarding these outcomes and to guide cardio-obstetric counseling.
Therefore, we examined cardiac function using contemporary echocardiographic parameters before and during
pregnancy and evaluated pregnancy outcomes in women with childhood cardiotoxic treatment exposure.
Method
A single-center retrospective observational cohort study was conducted among 39 women enrolled in the
late effect outpatient clinic of our institution. Information on cardiotoxic exposure at childhood, cancer
diagnosis and outcomes of all pregnancies were collected through interviews and review of health records.
Echocardiographic exams before and during pregnancy (1st trimester -T1; 2nd/ 3rd trimester – T23) were
retrospectively analyzed for left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). The
primary outcome was left ventricular dysfunction (LVD) during pregnancy defined as LVEF < 50% or decline of
10% in LVEF below normal (< 54%) and symptomatic heart failure (HF).
Results
Data could be collected from 91 pregnancies. In 22/39 women echocardiographic exams were available for
analysis. LVEF before pregnancy, in T1 and T23 was 55±6%, 52±7%, 53±7, respectively. LVD occurred in 9/22
patients (40.9%) and HF was not observed. When GLS was normal at baseline (< -18.0%; N&#3f12) none
of the patients developed LVD. In patients were GLS was abnormal at baseline 9/10 developed LVD later
in pregnancy. For patients with normal LVEF at baseline (≥ 54%) 3/15 developed LVD and in patients with
abnormal LVEF 6/7 developed LVD. Overall pregnancy outcomes were comparable to the national perinatal
outcome registry. However, in patients whom received total body irradiation (TBI, N&#3f4) outcomes were
poor: 7/16 pregnancies resulted in miscarriage and 4/16 resulted in very premature birth (before 32 weeks
gestational age).
Conclusion
Our study suggests that GLS may compliment LVEF in selecting patients who are at low risk for LVD during
pregnancy. Pregnancy outcomes are similar to the healthy population except when patients underwent TBI
during childhood.
________________________________________________________________________________________

P 30
Authors
Markella Printezi, Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands, Willeke Naaktgeboren, The
Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Amsterdam, the Netherlands | Julius Center for
Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands, Marjolein Essink,
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands, Arco
Teske, Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands, Wim Groen, The Netherlands Cancer
Institute, Division of Psychosocial Research and Epidemiology, Amsterdam, the Netherlands, Wim van Harten, The Netherlands Cancer
Institute, Division of Psychosocial Research and Epidemiology, Amsterdam, the Netherlands | Department of Health Technology and
Services Research, University of Twente, Enschede, the Netherlands | Rijnstate Hospital, Arnhem, the Netherlands, Martijn Stuiver, The
Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Amsterdam, the Netherlands | Center for Quality of
Life, the Netherlands Cancer Institute, Amsterdam, the Netherlands | Center of Expertise Urban Vitality, Faculty of Health, Amsterdam
University of Applied Sciences, Amsterdam, the Netherlands, Neil Aaronson, The Netherlands Cancer Institute, Division of Psychosocial
Research and Epidemiology, Amsterdam, the Netherlands, Tim Leiner, Department of Radiology, University Medical Center Utrecht,
Utrecht, the Netherlands | Department of Radiology, Mayo Clinic, Rochester, MN, USA, Maarten Cramer, Department of Cardiology,
University Medical Center Utrecht, Utrecht, the Netherlands, Linda van Laake, Department of Cardiology, University Medical Center
Utrecht, Utrecht, the Netherlands, Anne May, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht,
Utrecht University, Utrecht, the Netherlands

Association Between Anthracycline Timing and Cardiotoxicity Risk

Submission ID 1302495
Background
Anthracyclines (ACs) play a fundamental role in the treatment of various malignancies. However, their
cardiotoxic properties can lead to myocardial dysfunction and heart failure. Preclinical studies suggest
a circadian variation in AC cardiotoxicity. Here, we investigate the association between the timing of AC
administration (i.e. percentage administered in the morning) and cardiotoxicity in breast cancer patients.
Method
This study is a subanalysis of the Pact-Paces-Heart study, which studied the long-term cardiac effects of
chemotherapy in 185 breast cancer survivors who had participated in two randomized exercise trials (PACT
or PACES). The timing of AC treatments was collected retrospectively. Patients were included if ≥50% of
timepoints were identified. Regression analyses controlling for possible confounders were performed to
assess the association between percentage of chemotherapy received in the morning, which was defined as
as any time point earlier than 11 AM, and markers of cardiac damage obtained by cardiac magnetic resonance
imaging (extracellular volume (ECV), native T1, left ventricular ejection fraction (LVEF)) and echocardiography
(global longitudinal strain (GLS)). These markers were collected, on average, 8.2±1.1 years post-treatment.
Results
To date, the timing of AC administration has been collected for 110 study participants (59.5%), with a mean
age of 50.2±6.7 years at the start of treatment. Multiple linear regression indicated that a higher percentage
of morning treatment was significantly associated with a higher ECV (B=0.026, 95% CI [0.0098;0.0415]). No
significant association was found between the percentage of morning treatment and native T1 (B=0.132, 95%
CI [-0.1155;0.4136]), LVEF (B=0.003, 95% CI [-0.0373;0.0469]), or GLS (B=-0.002, 95% CI [-0.0200;0.0200]).
Updated results will be presented at the conference.
Conclusion
Our results suggest a time-dependent pattern of AC-induced structural myocardial damage in breast cancer
survivors, as reflected by a higher ECV in patients who received more of their treatment in the morning. A
randomized trial studying chronomodulated administration of ACs is needed before clinical recommendations
can be made.
________________________________________________________________________________________

P 31
Authors
Eduardo Zatarain Nicolas, Hospital Gregorio Marañón, Sara Pérez Ramirez, Hospital Gregorio Marañón, Javier De Castro Carpeño, La Paz
University Hospital, Ana Martin Garcia, University Hospital of Salamanca, Edel del Barco, HUSA-IBSAL, Juan Antonio Virizuela Echaburu,
Virgen de la Macarena University Hospital, Marinela Chaparro Muñoz, Hospital Virgen de la Macarena, Teresa Lozano Palencia, Dr. Balmis
General University Hospital, Alicante, Institute for Health and Biomedica, Natividad Martínez-Banaclocha, , Dr. Balmis General University
Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL, Dolores Mesa Rubio, Reina Sofía University Hospital, Juan De la
Haba, Reina Sofia University Hospital and Maimonides Institute for Research in Biomedicine of Cordoba (IMIBIC), María Amparo Martínez
Monzonis, , Santiago de Compostela University Hospital, A Coruña, Spain, Santiago Aguin Losada, , Santiago de Compostela University
Hospital, A Coruña, Spain, M CarmenGomez Rubin, Hospital Complex Ruber Juan Bravo, Patricia Cortez-Castedo, Hospital Ruber Juan
Bravo, Eduardo, Univiersity Hospital of Salamanca, RocioEiros Bachiller, University Hospital of Salamanca, Clara Sanchez Pablo, University
Hospital of Salamanca, Leticia Nieto Garcia, University Hospital of Salamanca, Andrea Gomez Sanchez, University Hospital of Salamanca,
Ivan Marquez Rodas, Hospital General Universitario Gregorio Marañón, Borja Ibañez, CNIC, Pilar Martin Fernandez, CNIC, Teresa Lopez-
Fernandez, La Paz University Hospital

Basal Characteristic of Patients Included in the Spanish Immunotherapy Registry of Cardiovascular

Toxicity, the Sir-cvt
Submission ID 1303055
Background
Immune check-point inhibitors (ICI) have improved outcomes, but its associated cardiovascular toxicity
(CVtox) could be threatening. There is a lack of evidence in surveillance protocols and how toxicity develops
is unknown, so early diagnosis is a challenge for the clinicians. Recently, a novel miRNA (miR-721) marker of
myocarditis has been described, including ICI-related myocarditis. Our aim is to prospectively describe the
ICI-related CVtox development and evaluate a specific follow-up protocol.
Method
A national multicentric, prospective, observational registry was designed in a translational research consortium
between the Spanish societies of Cardiology and Medical Oncology and the National Cardiovascular Research
Centre (CNIC). The protocol includes clinical and demographic variables, EKG, echocardiogram, cardiac
magnetic resonance (CMR), cardiac biomarkers, immunologic response and miR-721 analysis.
Results
53 patients (age 68 [59, 75] years, 79% male) have been enrolled by 8 hospitals during the first 6
months of the recruitment period. 83% patients have at least 1 CV risk factor. Basal characteristics
are described in table 1. 23% patients presented with dyspnoea, the EKG was abnormal in 28%
and 33% have increased values of cardiac biomarkers (hs-Troponin 5.30 [2.60, 11.00], NT-proBNP
199 [68, 736]). Mean LVEF and GLS were within the normal values (LVEF was 60% [56.15, 66.78] and

Cancer Type Treatment Setting ICL Treatment

 Renal n(%) Metastasic n(%) Pembrolizumab n(%)

 8 ( 16.7 38 (71.6) 24 (45.2)

Urothelial n(%) Adyuvance n(%) Nivolumab (monotherapy) n(%)

6 ( 12.5) 8 (16.7) 6 (11.3)

Lung (non schamous) n(%) Neoadyuvance n(%) Ipilimumab+Nivolumab n(%)

17 ( 35.4) 2 (4.2) 5 (9.4)

Lung (schamous) n(%) Atezolizumab n(%)

9 ( 18.8) 9 (16.9)
 Lung (Small-cell) n(%) Otros n(%)
1 (  2.1) 10 (18.8)

Melanoma n(%) Any concurrent chemotherapy n(%)

 7 ( 14.6)

Other n(%) Concurrent radiation n(%)

5 (9.4) 6 (12.8)

Conclusion
Baseline CV morbidity is high in a real-world cohort of patients with cancer referred to ICI therapy.
The rise in NTproBNP levels can reflect older age and myocardial fibrosis at baseline.
________________________________________________________________________________________

P 32
Authors
Yan Liu, Ascension Texas Cardiovascular

A Novel Cardio-Oncology Service Line Model in Optimizing Care Quality, Patient Access, and Health
Equity in a Large, Multi-hospital Health System
Submission ID 1303952
Background
Here we present a novel cardio-oncology service line model for large, multi-hospital health systems in
optimizing care quality, patient access, and health equity
Method
An academic cardio-oncology program was first established as the central program. We then proceeded with
service line development by first defining then implementing 5 key elements of infrastructure for a cardio-
oncology service line (Figure 1), strategic vision/accountability, standardized system of care, dedicated resources,
patient experience and education, and branding/identity. These elements were utilized in 6 different hospitals
and 8 different cardio-oncology clinics across our healthcare system to establish service line. For standardized
system of care, we successfully established patient referral and clinical workflow, imaging protocols, standard
result notification protocol, cardiotoxicity surveillance guide, clinical management protocol (Figure 2). . An IRB
approved cardio-oncology registry was also established for outcome tracking.
Results
After establishment of new cardio-oncology service line, the standardized cardio-oncology services were
expanded from one medical center to 6 different hospitals across hospital system, including two rural hospitals.
Outpatient cardio-oncology care was expanded from one location to 8 different outpatient care centers,
including 3 rural outreach offices. As a result, the cardio-oncology service area expanded from 274 square
miles to 4731 square miles and cardio-oncology office visits increased by over 200% first year and by 400%
in the second year after service line model established and implemented. In addition, cardio-oncology care
was made newly accessible to an estimated rural population of 204,133 after service line established. Primary
outcome endpoint measured by heart failure admission/readmission and hospital stay duration in cardio-
oncology patients significantly improved.
Conclusion
Cardio-oncology service line with key infrastructure elements centered on standardized system of care is a
feasible and effective care model to improve care quality, patient access, and health equity in large, multi-
hospital health systems; and it can be utilized to in conjunction with academic cardio-oncology programs to
improve the overall cardio-oncology healthcare efficacy
________________________________________________________________________________________

P 33
Authors
David Reeves, Franciscan Physician Network, Molly Russell, Franciscan Health, Vijay Rao, Indiana Heart Physicians

QTc Prolongation Risk Among Patients Receiving Oral Antineoplastic Medications

Submission ID 1304100
Background
Over 25 oral antineoplastic medications are associated with electrocardiogram (ECG) QTc prolongation. The
aims of this study were to describe QTc prolongation incidence among patients receiving oral antineoplastics
and identify potential risk factors.
Method
This was a retrospective review of patients initiated on oral antineoplastics known to prolong QTc interval at
a community-based cancer center. The primary endpoint was incidence of QTc prolongation (QTc > 470ms
in males/> 480ms in females at follow-up or >20ms increase from baseline). Secondary endpoints included
incidence of significant QTC prolongation (QTc > 500ms or > 60ms increase from baseline) or QTc prolongation
resulting in therapy discontinuation.
Results
Forty-nine patients with baseline and follow-up ECGs were included. Dasatinib, osimertinib, pazopanib, and
sunitinib accounted for 56% of patients in this cohort. Median time to follow-up ECG was 38 days. Twelve
patients (24%) developed QTc prolongation with 11 (22%) experiencing a >20ms increase from baseline and
4 (8%) with a QTc >470/480 at follow-up. Three (6%) developed significant QTc prolongation. Use of a
loop diuretic was more common in the group with QTc prolongation (42% vs 11%, p=0.029). Age, gender,
renal function, cardiovascular history, and diagnosis of diabetes were similar between groups. Mean baseline
QTc was similar between groups (437.4ms in those without QTc prolongation vs. 432.4ms in those with QTc
prolongation, p=0.614), as was the concomitant use of additional scheduled medications known to prolong
QTc at the time of follow up ECG (8% in both groups, p=1.00). No patients required discontinuation of oral
antineoplastic due to QTc prolongation.
Conclusion
Despite nearly a quarter of patients with observed QTc prolongation on oral antineoplastics known to prolong
QTc, no patients required discontinuation of therapy. It has been previously recommended that patients be
screened at baseline and after 14 days of therapy. Loop diuretic use was associated with greater frequency of
QTc prolongation. As such, it may be prudent to monitor more closely for electrolyte abnormalities due to the
potential increased QTc prolongation risk.
________________________________________________________________________________________

P 34
Authors
Author Tammy, Ditto, Author David, Reeves, Author Vijay, Rao

CardioOncology Smart Phrases: Leveraging the Electronic Medical Record to Improve Patient Care
Submission ID 1304505
Background
Oncology patients are benefitting from the rapid development and approval of novel oral antineoplastic
agents. However, many of these agents have off-target cardiovascular side effects. For the busy practicing
clinician, let alone cardio-oncologists, it is difficult to keep up-to-date on these toxicities. By leveraging the
electronic medical record (EMR) utilizing DOT smart phrases, clinicians may be able to improve communication
and provide actionable knowledge in real-time.
Method
“Utilizing the guidance provided in our recently published 2021 JACC: State of the Art Review, “Clinical
Approach to Cardiovascular Toxicity of Oral Antineoplastic Agents
Results
we created smart phrases in the EPIC EMR (.CODRUGNAME) for the 56 FDA approved drugs as of July 2020
that FDA labels recommended cardiac monitoring.
Conclusion
An example of one DOT smart phrase is included here:
.COZANUBRUTINIB
Drug Name, Generic: Zanubrutinib, Brand: Brukinsa
Mechanism of Action: BTK
Indications: Mantle Cell Lymphoma
Adverse Effects: Atrial Fibrillation ++ (+ = rare 10%)
Recommended Monitoring:
Baseline Testing: HR and ECG
During Treatment: HR daily home monitoring, correlate with in-clinic visits. ECG if s/sx of atrial arrhythmias
Drug Interactions: (+ = weak, ++ = moderate, +++ = strong, ns=not specified)
CYP3A4 substrate: avoid moderate to strong inhibitors and inducers
P 35
Authors
Juan Ramos, InCor, Isabelle Parahyba, InCor, Romulo Moraes, InCor, Rizek Hajjar, InCor, Bianca Barrese, InCor, Jissela Bagua, InCor,
Mariane Shinzato, InCor, Sthéphani Parreira, InCor, Silvia Fonseca, ICESP, Sthéphani Rizk, ICESP, Isabela Costa, InCor, Fernanda Andrade,
ICESP, Cristina Bittar, ICESP, ThalitaGonzalez, ICESP, Marilia Rehder, ICESP, Brunna, InCor, ValmirCosta, USP, Thiago Silva, ICESP, Nestor
Neto, ICESP, Alicia Veiga, InCor, Cecília Barros, InCor, Leticia Nakada, InCor, Lucas Kawahara, InCor, Julia Fukushima, ICESP, Ricardo Terra,
USP, Roberto Kalil Filho, InCor, Ludhmila Abrahão Hajjar, InCor

Cardiac Tamponade Is a Independente Risk Factor for In-hospital Mortality in Cancer Patients with Cardiac
Effusion
Submission ID 1304530
Background
Pericardial effusion is a frequent complication in cancer patients, associated with worse outcomes. More
common in patients with lung, breast and hematological malignancies, effusion can be due to direct invasion
of the pericardium, mass effect on lymphatic drainage or related to cardiotoxicity. The objective of this study
was to evaluate risk predictors of hospital death in cancer patients undergoing surgical pericardial drainage
using a database of 13 years in a tertiary reference center of oncology, the Cancer Institute of University of Sao
Paulo (ICESP).
Method
A retrospective study was carried out at ICESP, with all patients undergoing surgical pericardial drainage
between 2009 and 2022. We collected epidemiological and perioperative information, symptoms at admission,
organ dysfunction, previous cancer treatments and hospital death.
Results
Between 2009 and 2022, 322 patients were submitted to surgical drainage for pericardial effusion, of which
140 were men (44%), with a mean age of 54 years (17 - 87 years). Lung cancer was the most frequent (34.8%),
followed by breast (22.1%) and gastrointestinal tract (13%). The most common complaint at admission was
dyspnea (41%), followed by cough (11%) and chest pain (10%). In this sample, 39% of all patients had cardiac
tamponade diagnosed at admission through transthroacic echocardiogram. During hospital stay, the mortality
rate was 28.4% in this group of patients. In patients with cardiac tamponade, hospital mortality was 75%.
Cardiac tamponade was an independent risk fator for in-hospital mortality in cancer patients (OR 7.05 - CI 95%
4.1- 13.7, P< 0.001).
Conclusion
Pericardial effusion in cancer patients is a frequent complication with high mortality, even in a university referral
hospital. Identifying predictors of mortality such as cardiac tamponade, is useful to optimize strategies of
reducing complications in these patients.
________________________________________________________________________________________

P 36
Authors
Sibren Haesen, Hasselt University (BIOMED) - FWO, Manon Marie Jager, Hasselt University (BIOMED), Sarah D’Haese, Hasselt University
(BIOMED), Esther Wolfs, Hasselt University (BIOMED), Dorien Deluyker, Hasselt University (BIOMED), Virginie Bito, Hasselt University
(BIOMED)

Unraveling the Cardioprotective Effect of Pyridoxamine During Doxorubicin Chemotherapy: Focus on

Mitochondria and Inflammation
Submission ID 1304545
Background
Doxorubicin (DOX) is a cytostatic drug used to treat diverse cancer types. However, many cancer patients develop
cardiac dysfunction while effective cardioprotection is lacking. We have previously shown that the vitamin B6-
derivative pyridoxamine (PM) limits the development of DOX-induced left ventricular (LV) cardiomyopathy by
improving LV systolic function. However, the underlying mechanisms of the cardioprotective capacity of PM are
currently under investigation. We hypothesized that PM offers cardioprotection by interfering with myocardial
inflammation and mitochondrial loss.
Method
Female Sprague Dawley rats were weekly treated with DOX (2 mg/kg iv) or saline for eight weeks, with two
other groups also receiving PM (1 g/L, DOX+PM and saline+PM) via the drinking water (N&#3f5-9/group).
Hemodynamic RV measurements were performed in week 8. Stainings were performed to score the presence
of leukocytes and CD68+ macrophages in LV tissue and to measure the area occupied by mitochondria in
cardiomyocytes. Data were compared using 1-way ANOVA or Kruskal-Wallis test with post hoc tests.
Results
DOX-treated animals showed similar RV pressures (max and mean), systolic function (dP/dt max, contractility
index and systolic duration) and diastolic function (dP/dt min and diastolic duration) compared to the saline
group. DOX treatment resulted in increased immune cell infiltration in LV tissue with a significant increase of
CD68+ macrophages (p< 0.01 vs saline) but not leukocytes. The mitochondrial area was significantly decreased
in LV cardiomyocytes of DOX-treated animals (p< 0.01 vs saline). PM significantly prevented the reduction of
mitochondrial area (p< 0.05 DOX+PM vs DOX) but not the increase of CD68+ macrophages.
Conclusion
Although DOX impaired LV function in previous experiments, our data show that DOX does not alter RV
performance, implying that there is no sign of backward cardiac failure. In addition, we show that DOX
induces myocardial inflammation characterized by macrophage infiltration in LV tissue. PM limits DOX-induced
mitochondrial loss, highlighting its promising cardioprotective nature.
________________________________________________________________________________________

P 37
Authors
Miguel Fernandez de Sanmamed Girón, Hospital Universitario de Gran Canaria Doctor Negrin, Mario Galvan Ruiz, Hospital Doctor Negrin,
Carmen Acosta Calero, Hospital Doctor Negrin, Jonathan Deniz Rosario, Hospital Doctor Negrin, Belen Rojas Escriva, Hospital Doctor
Negrin, Beatriz Aguiar Bermudez, Hospital Doctor Negrin, Jesmar Alejandro Ramonis Quintero, Hospital Doctor Negrin, Javier Bautista
García, Hospital Doctor Negrin, Maria del Val Groba Marco, Hospital Doctor Negrin, David Ortiz Lopez, Hospital Doctor Negrin, Aridane
Cardenes Leon, Hospital Doctor Negrin, Melisa Karina Torres Ochando, Hospital Doctor Negrin, leslie gonzalez Pinedo, Hospital Doctor
Negrin, AntonioGarcia Quintana, Hospital Doctor Negrin, Maria del Mar Perera Alvarez, Hospital Doctor Negrin, Eduardo Jose, Hospital
Doctor Negrin

Application of a Prediction Model of Cardiovascular Events in a Cohort of Patients with Hematopoietic

Stem Cell Transplantation
Submission ID 1304660
Background
Hematopoietic Stem Cell transplantation (HSCT) is one of the main treatments for hematological malignancies.
We need to consider several factors (preexisting comorbidities, HCST type, or therapies received) to assess
cardiovascular toxicity risk. The objective of our study is to apply in our population the prediction model for
the appearance of cardiovascular disease after HSCT based on cardiovascular risk factors (CVRF) described by
Armenian et al.
Method
A retrospective analysis was carried out of all patients who received HSCT (autologous and allogenic) in the
hematology service of our center between January 2018 and January 2022.
Results
252 patients were included, 43,4 % were women, with a mean age of 52.7 ± 13.9 years. Focusing
on cardiovascular risk factors, high blood pressure was presence on 30.6% patients, diabetes on
11.1% and dyslipidemia on 17.5%. Risk of cardiovascular disease was calculated in all patients,
observing that 67.5% belonged to the low risk group, 29% to medium risk and 3.6% to high risk.
Acute myeloid leukemia was the most common disease (n=63, 25%) followed
by multiple myeloma (n=52, 20.6%). 59.9% (n=145) of the patients received
anthracyclines in chemotherapy. Of the HSCT, 54% were allogenic and 46% autologous.
Of our total sample, 26 patients (10.3%) developed cardiovascular disease, of which 22 died during follow
up. No significant difference was observed in the incidence of cardiovascular disease during follow-up. After
performing a survival analysis, an increase in mortality from all causes was observed in group 3, in a probable
context of greater comorbidity (image 1).
Conclusion
In our series, the calculation of cardiovascular risk described by Armenian et al. was correlated with all-cause
mortality, without reaching statistical significance regarding cardiovascular events.
________________________________________________________________________________________

P 38
Authors
Nazanin Aghel, McMaster University, Vincent Wang, McMaster University, Jasmine Kang, Michael G. DeGroote School of Medicine,McMaster
University, Jennifer Wiernikowski, Hamilton Health Sciences, Dina Khalaf, McMaster University, Michelle Lui, Hamilton Health Sciences
Centre, Livia Fu, Hamilton Health Sciences - Juravinski Hospital, Harry Klimis, McMaster University, Christopher Hillis, McMaster University,
Darryl Leong, McMaster University
Cardiovascular Events in the First 100 Days After Allogeneic Hematopoietic Stem Cell Transplantation
Submission ID 1304686
Background
Allogeneic hematopoietic stem cell transplantation (HSCT) is a proven curative treatment for several otherwise
fatal malignancies involving the hematopoietic system. Despite its success, allogeneic HSCT remains limited
by toxicities in the early post-transplantation period. There are scant contemporary data on the incidence, and
potential determinants of acute cardiovascular (CV) events post allogeneic HSCT.
Method
This retrospective study included 525 consecutive patients (median age 53, male 59.43%) with hematological
malignancies who underwent allogeneic HSCT between 2004 and 2021 in Hamilton, Ontario, Canada.
Results
Two hundred eighty-four (55%) received myeloablative and 231 (45%) received nonmyeloablative/reduced-
intensity conditioning (NMA/RIS) regimens. Patients who received NMA/RIS regimens were older (P< 0001)
and had a higher frequency of pre-existing CV disease (p= 0.028). Twenty-nine (5.52%) patients developed CV
events. The most frequent CV event in the first 100 days post-HSCT was atrial fibrillation (n=17,3.24%), followed
by heart failure (1.91%). Four patients (0.76%) died due to CV events. CV death was responsible for 9.3% of
non-relapse mortality in 100 days. In multivariable analyses incorporating age, sex, type of conditioning, prior
history of heart failure, atrial fibrillation, hypertension, CV disease and left ventricular (LV) dysfunction (i.e., EF<
50%), only age (per one-year increase, OR: 1.04, 95% CI: 1.001-1.084; P= 0.044) and LV dysfunction before
transplant (OR: 4.479, 95% CI: 1.588- 12.636; P=0.005) were independently associated with the increased rate
of CV event.
Conclusion
Atrial fibrillation was the most common CV event after HSCT. Serious CV events and CV death were not
common. Older age at the time of HSCT and prior LV dysfunction (i.e., EF< 50%) were independently associated
with the increased rate of CV events. Pre-existing CV disease did not increase the risk of CV events 100 days
post-HSCT. Considering the findings of this study, patients with a pre-existing cardiac condition should not
be denied HSCT. Future prospective studies are required to investigate the risk of CV events and non-relapse
mortality in patients with pre-existing cardiac conditions.
________________________________________________________________________________________

P 39
Authors
Adam El-Kadi, PHRI, McMaster University, Daniel Rayner, PHRI, McMaster University, Jonathan Monteiro, PHRI, McMaster University, Olsen
Chan, PHRI, McMaster University, Shijie Zhou, McMaster University, Harry Klimis, PHRI, McMaster University, Darryl Leong, McMaster
University, Filipe Cirne, McMaster University

Cardiovascular Disease and Death in Patients with Prostate Cancer: A Systematic Review of Contemporary
Prospective Cohorts
Submission ID 1304767
Background
Cardiovascular disease (CVD) is the most common cause of death in patients with localized prostate cancer
(PCa) and the second most common in those with advanced disease. The objective of this study was to identify
high-quality prospective cohort data to inform risk factors for CVD and rates of cardiovascular (CV) events in
men with PCa. The CV events considered were CV death, myocardial infarction, stroke/TIA and heart failure.
Method
In this systematic review, we included prospective cohorts of PCa patients with a sample size of at least 1,000
participants or at least 100 deaths/CV events. Administrative database studies were excluded due to incomplete
data on CV risk factors (e.g., obesity, smoking). We extracted data on CV risk factors, comorbidities, and CV
events, when available. The risk of bias was assessed by the Newcastle-Ottawa Scale. All study processes
were conducted in duplicate by independent investigators. The review was pre-registered in PROSPERO
(CRD42021279191).
Results
Eighteen (18) studies fulfilled the eligibility criteria. Data were not appropriate to permit meta-analysis.
Captured risk factors included age, hypertension, diabetes, dyslipidemia, smoking habit and obesity. Six of
18 studies did not report any modifiable risk factors at baseline, one study reported only one of these risk
factors, four studies reported on two, five studies reported on three and two studies reported on four of them.
Although the majority reported rates of overall death, only two studies reported rates of CV death. None of
the included studies reported on the rates of non-fatal CVD during follow-up. Androgen deprivation therapy
(ADT) was used in 39.3% of the participants, but the type of ADT was seldom reported. Half of the included
studies had a high risk of bias.
Conclusion
There is a paucity of prospective data to inform rates of CV events and death in patients with PCa, as well
as what cardiovascular risk factors are important in this population. Therefore, future prospective studies are
needed to reliably inform on rates of CV events in patients with PCa and to explore the role of different types
of ADT and its relationship with conventional cardiometabolic risk factors.
________________________________________________________________________________________

P 40
Authors
Ibrahim Ahmed, Mercy Catholic Medical Center (Drexel University)

Atrial Fibrillation in Malignant Lung Cancer Patients – Disparities and Cardiovascular In-Hospital Outcomes
Submission ID 1306968
Background
Atrial fibrillation (AF) is a common arrhythmia that is associated with malignant lung cancer (LCA), but little is
known about the impact of AF in LCA patients. Our aim was to investigate the effect of AF on LCA.
Method
Retrospective cohort study using the 2019 Nationwide Inpatient Sample database to identify admissions in
adults with diagnoses of LCA and AF. Multivariate regression models adjusted for demographics were used.
Primary outcome was mortality, and secondary outcomes were length of stay (LOS) and total charge.
Results
Out of 423760 malignant lung cancer admissions, 42035 had atrial fibrillation. Compared
to Non-AF-LCA cohort, AF-LCA cohort had fewer females (44.42% vs 49.68%,p75th
percentile] (25.24% vs 24.02%,p< 0.001), and Medicare (79.01% vs 65.92%,p< 0.001).

AF-LCA cohort had more STEMI (0.55% vs 0.33%,p< 0.01), dementia (4.91% vs 4.16%,p< 0.001), hypertension
(38.12% vs 20.52%,p< 0.001), obesity (11.28% vs 9.29%,p< 0.001), diabetes mellitus (17.99% vs 13.41%,p<
0.001), hypothyroidism (16.99% vs 13.92%,p< 0.001), but less depression (12.26% vs 13.39%,p< 0.01), alcohol
abuse (3.16% vs 3.81%,p< 0.01), drug abuse (1.78% vs 2.42%,p< 0.001), NSTEMI (0.27% vs 1.29%,p< 0.001),
cerebral infarction (0.28% vs 1.99%,p< 0.001), cerebral hemorrhage (0.09% vs 1.16%,p< 0.01), supraventricular
tachycardia (0.51% vs 1.85%,p< 0.001), ventricular tachycardia (0.34% vs 1.18%,p< 0.001), ventricular fibrillation
(0.04% vs 0.16%,p< 0.001), systolic (1.00% vs 3.81%,p< 0.001) & diastolic (1.75% vs 5.83%,p< 0.001) heart failure.

AF-LCA cohort had higher mortality rate (9.08% vs 8.15%,p< 0.01), mortality OR 1.10 (95%CI 1.01-1.20,p<
0.05), higher mean LOS (7.22 vs 5.88 days,p< 0.001), and higher mean total hospitalization charge ($86894.06
vs $71730.60,p< 0.001).
Conclusion
In patients admitted with LCA, the presence of AF was associated with higher all-cause mortality rate, odds of
mortality, mean LOS, and mean total hospitalization charge. AF was also associated with more white males,
highest household income quartile, Medicare, STEMI and dementia, but less arrhythmias, heart failure and
stroke.
________________________________________________________________________________________

P 41
Authors
Teresa Lopez-Fernandez, La Paz University Hospital, Eduardo Zatarain Nicolas, Hospital Gregorio Marañón, Rosa Jiménez-Alejandre, CNIC,
Ignacio Ruiz-Fernández, CNIC, Javier De Castro Carpeño, La Paz University Hospital, Sara Pérez Ramirez, Hospital Gregorio Marañón,
Edel del Barco, HUSA-IBSAL, Silvia Valbuena López, Hospital universitario la paz, Laura Gutierrez, La Paz University Hospital, Ana Martin
Garcia, University Hospital of Salamanca, Juan Antonio Virizuela Echaburu, Virgen de la Macarena University Hospital, Belen Terol, La
PAz university Hospital, Dolores Mesa Rubio, Reina Sofía University Hospital, MarinelaChaparro Muñoz, Virgen Macarena University
Hospital, Teresa Lozano Palencia, Dr. Balmis General University Hospital, Alicante, Institute for Health and Biomedica, Natividad, , Dr.
Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL, SantiagoAguin Losada, , Santiago de
Compostela University Hospital, A Coruña, Spain, Juan De la Haba, Reina Sofia University Hospital and Maimonides Institute for Research
in Biomedicine of Cordoba (IMIBIC), María Amparo Martínez Monzonis, , Santiago de Compostela University Hospital, A Coruña, Spain,
Carlo Gabriele Tocchetti, Federico II University, Naples, Italy, and Center for Basic and Clinical Immunology Research (CISI),, Borja Ibañez,
CNIC, Pilar Martin Fernandez, CNIC

Immunologic Phenotype of Patients Included in the Spanish Immunotherapy Registry (SIR-CVT Registry)
Submission ID 1307004
Background
Immune checkpoint inhibitors (ICI) play a fundamental role in the management of cancer. However, they
can cause immune-related adverse effects (ir-AE) since autoimmune T-cell clones such as Th17 cells are also
activated. Currently, we do not have evidence-based guidelines for ICI treatment surveillance. The SIR-
CVT registry is a translational, multicenter, and multidisciplinary prospective registry led by the Sociedad
Española de Oncología Médica (SEOM), Sociedad Española de Cardiología (SEC) and Centro Nacional de
Investigaciones Cardiovasculares (CNIC) and set out to define the CV toxicity risk profile and the optimal CV
monitoring strategies for patients receiving ICI. To understand the impact of the activation of the immune
system on the ICI-related CV toxicity risk we have also studied the immunological characteristics in peripheral
blood of patients before and during ICI treatment.
Method
Blood flow cytometric analysis of 45 ICI-treated patients was performed at baseline and at 2-4 weeks(V1),
10-12 weeks (V2), and 6 months (V4) after ICI treatment. Cells were cultured for 18 hours and stimulated with
anti-CD3, -CD28 and IL-2. Membrane labeling was performed with CD45RA, CD45RO, CD4, CD25 and CD69
antibodies, intracellular labeling with IFN-gamma, IL-17, IL-22 antibodies, and intranuclear labeling with anti-
Foxp3. Data were analyzed on a FACSymphony (BD) with a FlowJo10.1 software.
Results
Patients treated with ICI do not show significant changes in the total population of CD4 T cells; however, a
trend towards an increase in memory T cells was observed. In the first weeks of treatment, a very significant
drop in activated regulatory T cells (CD4 CD25 CD69+ Foxp3) was observed, while IFN+ T cells were not
altered by treatment. Autoimmune T cells or Th17 cells increase significantly after V2, which can cause multiple
autoimmune disorders (Figure 1: immune profile (CD4, Treg naive, Treg memory, Treg CD69, Th1, TH17,
CD4IL22, CD4IL22IL17, Ratio TH17/treg) of blood samples from patients treated with ICI therapy)
Conclusion
Patients with cancer treated with ICI present an initial decrease in circulating regulatory T cells, which leads
to the activation of Th17 cells. The analysis of the immune response will help us study the development of
immune-mediated adverse effects, including myocarditis
________________________________________________________________________________________

P 42
Authors
Teresa Lopez-Fernandez, La Paz University Hospital, Eduardo Zatarain Nicolas, Hospital Gregorio Marañón, Rosa Jiménez-Alejandre,
CNIC, Ignacio Ruiz-Fernández, CNIC, Javier De Castro Carpeño, La Paz University Hospital, Sara Pérez Ramirez, Hospital Gregorio
Marañón, Ana Martin Garcia, University Hospital of Salamanca, Edel del Barco, HUSA-IBSAL, Teresa Lozano Palencia, Dr. Balmis General
University Hospital, Alicante, Institute for Health and Biomedica, Natividad Martínez-Banaclocha, , Dr. Balmis General University Hospital,
Alicante Institute for Health and Biomedical Research (ISABIAL, Marinela Chaparro Muñoz, Virgen Macarena University Hospital, Juan
Antonio Virizuela Echaburu, Virgen de la Macarena University Hospital, María Amparo Martínez Monzonis, , Santiago de Compostela
University Hospital, A Coruña, Spain, SantiagoAguin Losada, , Santiago de Compostela University Hospital, A Coruña, Spain, Dolores
Mesa Rubio, Reina Sofía University Hospital, Juan, Reina Sofia University Hospital and Maimonides Institute for Research in Biomedicine
of Cordoba (IMIBIC), LauraGutierrez, La Paz University Hospital, Belen Terol, La PAz university Hospital, Silvia Valbuena López, Hospital
universitario la paz, Carlo Gabriele Tocchetti, Federico II University, Naples, Italy, and Center for Basic and Clinical Immunology Research
(CISI),, Borja Ibañez, CNIC, Pilar Martin Fernandez, CNIC

Immunologic Phenotype of Patients Included Inthe Spanish Immunotherapy Registry (sir-cvt Registry)
Submission ID 1308737
Background
Immune checkpoint inhibitors (ICI) play a fundamental role in the management of cancer. However, they can
cause immune-related adverse effects (ir-AE) related with the activation of autoimmune T-cell clones such
as Th17 cells. Currently, we do not have evidence-based guidelines for ICI treatment surveillance. The SIR-
CVT registry is a translational, multicenter, and multidisciplinary prospective registry led by the Sociedad
Española de Oncología Médica (SEOM),Sociedad Española de Cardiología (SEC) and Centro Nacional de
Investigaciones Cardiovasculares (CNIC) and set out to define the CV toxicity risk profile and the optimal CV
monitoring strategies for patients receiving ICI. To understand the impact of the activation of the immune
system on the ICI-related CV toxicity risk we have also studied the immunological characteristics in peripheral
blood of patients before and during ICI treatment.
Method
Blood flow cytometric analysis of 45 ICI-treated patients was performed at baseline and at 2-4 weeks (V1),10-
12 weeks (V2), and 6 months (V4) after ICI treatment. Cells were cultured for 18 hours and stimulated with
anti-CD3, -CD28 and IL-2. Membrane labeling was performed with CD45RA, CD45RO, CD4, CD25 and CD69
antibodies, intracellular labeling with IFN-gamma, IL-17, IL-22 antibodies, and intranuclear labeling with anti-
Foxp3. Data were analyzed on a FAC Symphony (BD) with a FlowJo10.1 software
Results
Patients treated with ICI do not show significant changes in the total population of CD4 T cells; however, a
trend towards an increase in memory T cells was observed. In the first weeks of treatment, a very significant
drop in activated regulatory T cells (CD4 CD25 CD69+ Foxp3) was observed, while IFN+ T cells were not
altered by treatment. Autoimmune T cells or Th17 cells increase significantly after V2, which can cause multiple
autoimmune disorders (Figure 1)  https://www.dropbox.com/scl/fi/kaxp4c2an1tseevh6xnsp/FigureSIRCVT.
docx?dl=0&rlkey=t1mp8l0laau6e9jlxo8wl71zm
Conclusion
Patients with cancer treated with ICI present an initial decrease in circulating regulatory T cells, which leads
to the activation of Th17 cells. The analysis of the immune response will help us study the development of
immune-mediated adverse effects.
_______________________________________________________________________________________

P 43
Authors
Michelle Saba, Cardio-Onco Foundation, Stefanie Mundnich, Cardio-Onco Foundation, Christopher Tabilo, Red Salud Vitacura

Cardio-oncology Rehabilitation Program in a Medium Income Country

Submission ID 1308858
Background
The principal objective of oncology is to increase global survival with a good quality of life. Besides tumor
progression, cardiovascular events are the most frequent threat to overall survival, because they limit
oncological treatment, deteriorate functional capacity and can cause death. We describe our single center
experience in the implementation of a Cardio-oncologic Rehabilitation Program.
Method
If a patient needs oncologic treatment, he has a proven benefit from exercise. The oncologist should
perform a cardio-oncology risk evaluation. If the patient has a high risk or very high-risk of developing
cardiotoxicity, there must be a cardio-oncology consultation to mitigate the cardiovascular events risk. 
After the medical evaluation, the patient is referred to the exercise program, which includes a nutritional
consultation. Every patient has an evaluation session, to understand the oncology treatment prescribed,
the contraindications of exercise, the patient’s goals and expectations, and request of recent complete
blood count or other tests if necessary. The objective functional appraisal uses a short physical performance
battery. In most patients we perform a 2 minutes’ walk test and evaluate joint range of motion. 
In the first session, the exercise is tapered to the 60% of the maximum theoretical heart rate (MTHR) or
a modified Borg scale up to 4. In the following 10 sessions, he should achieve 60 to 80% of the MTHR
or 4 to 6 in the modified Borg scale. The routine includes aerobic exercise with treadmill or static
bicycle, dynamic and static balance work, and strength training with progressive load increase.   
The outcome desired is an equivalent of 7 METS, but in some patients - especially in palliative care – the
endpoints are adjusted to achieve a functional capacity.
Results
In 18 months, 110 patients have successfully completed the cardio-oncology rehabilitation program from at
least 10 oncology centers in our country. The 100% of the population were in chemotherapy of which a 70%
were in adjuvant or neo-adjuvant therapy. 
Conclusion
It is feasible to launch a rehabilitation program in a medium to low-income country but it is necessary to
design proper clinical protocols to include this in the patient’s journey. 
_______________________________________________________________________________________

P 44
Authors
Elsayed Ibrahim, Medical College of Wisconsin, John Charlson, Medical College of Wisconsin

Early Markers of Chemotherapy-induced Acute Myocardium Structural Changes by MRI

Submission ID 1309508
Background
Chemotherapy is a mainstay of cancer treatment. The most important late side effect of chemotherapy is
cardiotoxicity, which may progress to heart failure. Nevertheless, the short-term acute effects of chemotherapy
on cardiac function and myocardium tissue structure are not well elucidated.
Method
In this IRB-approved study, five (3m/2f) cancer patients (three sarcoma and two breast cancer) scheduled for
chemotherapy underwent pre-treatment cardiac MRI, and three of them underwent post-treatment (within 2
weeks) cardiac MRI on a 3T GE MRI scanner. The images were analyzed to measure global cardiac function
(LV indexed end-diastolic (EDVi), end-systolic (ESVi), and stroke (SVi) volumes, mass, and EF), regional cardiac
function (global longitudinal (GLS), circumferential (GCS), and radial (GRS) strains, diastolic strain rates (SR),
and torsion), and tissue characteristics (T1, T2 maps).
Results
As shown in Table 1 / Fig 1, LV volumes and EF showed slight increases and decrease, respectively, post-
treatment. Myocardial strain and strain rates increased (in absolute values), albeit insignificantly, post
treatment, while LV torsion slightly decreased. T1 values slightly increased, especially at the basal and
mid-ventricular levels, post-treatment. T2 values showed similar values at pre- and post-treatments.
Conclusion
MRI is a valuable technique for detailed evaluation of transient cardiac changes post chemotherapy.
The changes in MRI parameters could be attributed to ventricular remodeling in response to injury from
chemotherapy. These imaging biomarkers would allow for early detection of subclinical cardiotoxicity and
improved outcomes.
_______________________________________________________________________________________

P 45
Authors
Elsayed Ibrahim, Medical College of Wisconsin, Elizabeth Gore, Medical College of Wisconsin, Carmen Bergom, Washington University

MRI for Characterizing Baseline Cardiac Function in Thoracic Cancer Patients Receiving Radiotherapy
Submission ID 1309538
Background
Radiation therapy (RT) plays a key role in treating lung cancer, although the incidence of RT-induced cardiac
complications could be as high as 33%. Nevertheless, the characteristics of baseline cardiovascular function
in this patient population is not well elucidated.
Method
In this IRB-approved study, six patients diagnosed with lung cancer and scheduled for RT underwent a
comprehensive cardiac MRI exam that included cine, tagging, T1/T2 mappings, and 4D flow sequences. The
tagged images were analyzed to measure myocardial strain. The 4D flow images were analyzed to measure
flow and velocity in the aorta, pulmonary artery & mitral and tricuspid valves and compared to two healthy
volunteers.
Results
EF was normal in all patients (57±3%). All strain measurements (Fig 1) were below normal range (absolute value <
17% ): GLS = -15±0.9%, GCS = -10±0.9%, GRS = 16±4.4%. Myocardial T1 & T2 values in the patients (1267±68 ms
& 53±1.3 ms) were slightly higher than in volunteers (1233±156 ms & 48±1.2 ms). Flow and velocity measurements
showed different patterns in patients vs volunteers (Table 1). Velocity at all measurement sites in the patients
were lower than in volunteers. LV and RV Early-to-atrial filling ratios in the patients were lower than in volunteers.
Table 1. Hemodynamic parameters (mean±SEM) in patients & volunteers. (*) indicates statistical significance. 
Conclusion
Lung cancer patients undergoing RT have borderline cardiac function and myocardial strain measurements
below normal values. Myocardial T1/T2 values in the patients are slightly high and the hemodynamic
measurements show different patterns than normal volunteers. Therefore, baseline cardiovascular condition
should be taken into consideration as a contributing factor in RT-induced cardiotoxicity.
_______________________________________________________________________________________

P 46
Authors
Julia Rickard, Faculty of Kinesiology and Physical Education, University of Toronto, Rebecca Christensen, Dalla Lana School of Public
Health, University of Toronto, Stephanie Small, Faculty of Kinesiology and Physical Education, University of Toronto, Husam Abdel-
Qadir, Cardiovascular Division, Department of Medicine, Women’s College Hospital, Amy Kirkham, Faculty of Kinesiology and Physical
Education, University of Toronto

Cardiometabolic and Lifestyle Determinants of Cardiovascular Disease Risk in Breast Cancer Survivors
Submission ID 1310349
Background
Breast cancer survivors experience 3 to 6-fold greater cardiovascular disease (CVD) mortality compared to
the general population. The etiology of the increased risk is proposed to be pre-existing risk factors for CVD,
cancer treatment-related cardiotoxicity, and lifestyle toxicity (e.g., physical inactivity, poor diet, smoking).
The purpose of this study was to evaluate the influence of breast cancer on the relationship between lifestyle
behaviours and CVD outcomes among women in the UK Biobank cohort.
Method
Data from the UK Biobank baseline assessment and 12.9 years of follow-up were analyzed for 6,787 women
with a history of breast cancer and 172,330 women without a history of any cancer type. Linear regression
was used to evaluate differences in baseline Framingham 10-year CVD risk by breast cancer status. Adjusted
modified Poisson regression was used to examine the association between baseline lifestyle risk factors and
incident CVD events (hospitalizations or mortality via ICD-10 codes) in follow-up. A first-order interaction was
included between breast cancer status and each lifestyle risk factor to assess for effect measure modification.
Results
At baseline, after adjustment for age, the Framingham 10-year CVD risk was not significantly different between
breast cancer survivors and women without cancer (10.4 vs 8.6%, p=0.35). However, over a median follow-
up of 12.9 years, nearly 20% of breast cancer survivors experienced a CVD event, which was greater than
women without cancer (adjusted risk ratio=1.15, 95% CI=1.10, 1.21). Among all women combined, there was
a significant association (p< 0.05) between lifestyle behaviours, including moderate and vigorous physical
activity, vegetable intake, fruit intake, and smoking status with CVD events, with no interaction by breast
cancer status (p >0.05).
Conclusion
Physical inactivity, fruit and vegetable intake, and smoking play a significant role in the risk of CVD events
among women with and without breast cancer. This finding suggests that multimodal CVD risk reduction
strategies such as cardio-oncology rehabilitation may be effective for breast cancer survivors.
_______________________________________________________________________________________

P 47
Authors
ANUPRITA DADDI, TATA MEMEORIAL CENTRE, Sheela Sawant, TATA MEMORIAL CENTRE, aruna alaharidhir, TATA MEMORIAL CENTRE

Multimodality Imaging in Cardiac Masses -Experience of Cardio-Oncology Clinic of Tertiary Cancer

Institute
Submission ID 1311192
Background
With focus of cardio-oncology being  preventing and treating the adverse cardiovascular complications
of cancer therapy .Echocardiography plays an essential role from baseline assessment to detection and
surveillance . Most cardiac masses are detected incidentally on routine echocardiography . Cardiac Metastasis
is known to be 30 times more common than primary cardiac tumours. More often seen are tumour thrombosis
,thrombi or Vegetations. Multimodality imaging is  further needed to characterise the mass, differentiating a
tumour from thrombus .
Method
A retrospective study of 80 patients with incidental  cardiac masses on routine echo study  who were
further  evaluated with multimodality imaging either FDGPET CECT ,CT Pulmonary Angio or  CMR for
characterisation of intracardiac masses
Results
43,820 echocardiography study were performed from Jan 2018 –June 2022, 80  pts were diagnosed with
cardiac masses .30% vegetations ,8.8% left ventricular clot due to regional wall motion abnormalities were
excluded from further analysis .The remaining 61.3 %  patient diagnosed with  thrombus were analysed  .
Most of them had  thoracic ,gastrointestinal and urological malignancy .Most patients had advanced stage 
at time of cancer diagnosis.34.9% were below 40 years of age. Commonest site was right atrium (RA)55%
. For further characterisation of thrombus 51% underwent contrast-enhanced computed tomography ,27%
fluorodeoxyglucose positron emission tomography (FDG PET )imaging  , 12%pulmonary angiography and
12% Cardiac Magnetic resonance imaging (MRI ).50% patients confirmed to have   tumour thrombosis ,3
patient confirmed to have myxoma ,one RA , two LA myxoma ,two patient underwent surgical removal of
myxoma after completion of cancer directed treatment .22 patient of tumour thrombosis received treatment
for underlying disease .5.1% patient declared Basic supportive care ,50% patients with confirmed bland
thrombosis  received  long term anticoagulation therapy . 20.40% had complete resolution of thrombus ,39%
are ongoing treatment. 41% expired due to advance disease
Conclusion
Most cardiac masses are detected incidentally on routine cardiac imaging  .CMR and FDG PET are useful
advanced imaging modalities which help in further characterisation of intracardiac masses, which can have
impact on management of primary cancer.
P 48
Authors
Paola Gonzalo-Encabo, Dana-Farber Cancer Institute, Nathalie Sami, University of Southern California, Dong-Woo Kang, Dana-Farber
Cancer Institute, Rebekah Wilson, Dana-Farber Cancer Institute, Cami Christopher, Dana-Farber Cancer Institute, Amber Normann, Dana-
Farber Cancer Institute, Christina Dieli-Conwright, Dana-Farber Cancer Institute

Exercise Reduces the 10-year Risk of Developing Cardiovascular Disease in Hispanic and Latina Breast
Cancer Survivors
Submission ID 1311202
Background
Compared to non-Hispanic Whites, Hispanic and Latina breast cancer survivors have an increased risk for
cardiovascular disease (CVD) related mortality, partly due to cancer treatment side effects and/or comorbidities.
We previously reported that supervised aerobic and resistance exercise improves Framingham risk score (FRS),
a clinical tool to predict the 10-year risk of developing CVD, in breast cancer survivors, yet it is unclear as to
whether exercise reduces FRS in Hispanic breast cancer survivors. The purpose of this secondary analysis was
to examine the effects of a 16-week aerobic and resistance exercise intervention on FRS among Hispanic and
Latina breast cancer survivors.
Method
Sedentary, overweight or obese (BMI >25.0 kg/m2), Hispanic and Latina breast cancer survivors (Stage I-III)
were randomized to exercise (n=29) or usual care (n=27). The thrice weekly 16-week intervention included
supervised moderate-to-vigorous aerobic (65-85% maximum heart rate) and resistance (65-85% 1-repetition
maximum) exercise. FRS was calculated for each participant at baseline and week 17 using an established
formula that incorporates data on age, systolic blood pressure (SBP), high-density lipoprotein cholesterol
(HDL-C), low-density lipoprotein (LDL-C), diabetes presence, and smoking status. Differences in mean changes
for outcomes were evaluated using mixed-model repeated measure analyses.
Results
Participants were 46±10 years old, obese (34.9±6.2 kg/m2), and most underwent a mastectomy (90%) and
chemotherapy + radiation therapy (77%). Adherence to the intervention was 95% and post-intervention
assessments were available on 98% of participants. Post-intervention FRS was significantly reduced in the
exercise group compared to the usual care group (mean difference -12.5; 95% CI -16.0, -4.0), which corresponds
to a 15% (95% CI: -18.0,-3.0) decrease in 10-year risk of developing CVD. 
Conclusion
A 16-week supervised aerobic and resistance exercise intervention effectively may reduce the 10-year risk of
developing CVD in overweight and obese Hispanic and Latina breast cancer survivors. 
________________________________________________________________________________________

P 49
Authors
Clare Bannister, King’s College Hospital NHS Foundation Trust, Antonio Cannata, King’s College London, Daniel Bromage, King’s College
Hospital, Theresa McDonagh, King’s College Hospital

A Study to Assess the Predictive Accuracy of the HFA/ICOS Baseline Risk Stratification Tool for Myocardial
Injury Following Anthracycline Chemotherapy
Submission ID 1311224
Background
Anthracyclines are a highly effective class of chemotherapy; however, their use is complicated by the risk of
cardiotoxicity. The Heart Failure Association (HFA) and International Cardio-Oncology Society (ICOS) have
jointly published a novel cardiovascular risk stratification tool which categorises patients according to their
risk of cardiotoxicity. Troponin is an established biomarker of cardiomyocyte necrosis and an early marker of
anthracycline cardiotoxicity. In this study, we test the ability of the HFA/ICOS tool to predict early myocardial
injury defined as an abnormal troponin concentration after anthracycline treatment.
Method
Outpatients who received anthracycline chemotherapy from October 2020 to June 2022 were prospectively
enrolled. Patients were classified into low/medium/high/very high baseline risk categories using the HFA/
ICOS tool. High sensitivity troponin T (hsTnT) was measured prior to each chemotherapy cycle (peak value
used in analysis).
Results
100 outpatients received anthracycline treatment during the study period. The most common indications
were breast cancer (55%) and diffuse large B cell lymphoma (28%). Using the HFA/ICOS tool, 64%
of patients were deemed low risk, 21% medium risk, 16% high and 0% very high risk at baseline.
 
By the end of anthracycline chemotherapy, 52% of patients developed an abnormal hsTnT
(≥14ng/L) indicating myocardial injury. There was a significant association between baseline risk
categorisation and the development of an abnormal hsTnT, with medium and high-risk patients
more likely to develop an abnormal hsTnT concentration compared to low-risk patients (p=0.001).
 
The mean hsTnT concentration increased incrementally as the baseline risk of cardiotoxicity increased,
with the highest mean hsTnT concentration in those patients deemed high risk. (Fig 1, p< 0.05).
Fig 1. hsTnT concentration according to risk categorisation
Risk Categorisation Mean high sensitivity troponin T concentration (ng/L) Low 17.4 ± 1.8 Medium 35.3 ± 6.6 High 
 45.3 ± 16.6 ** p< 0.05 vs. low riskMean ± s.e.m
Conclusion
The novel HFA/ICOS risk stratification tool is useful in predicting patients who will develop early myocardial
injury following anthracycline chemotherapy. This cohort will be prospectively followed to assess longer term
cardiac outcomes according to their risk categorisation.
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P 50
Authors
Zsofia Drobni, Heart and Vascular Center, Semmelweis University, Giselle Suero-Abreu, Massachusetts General Hospital, Sofia Nikolaidou,
Massachusetts General Hospital, Thiago Quinaglia, Massachusetts General Hospital, Terry Ho, Massachusetts General Hospital, Hannah
Gilman, Massachusetts General Hospital, Sama Supraja, Massachusetts General Hospital, Bela Merkely, Massachusetts General Hospital,
Ryan Sullivan, Massachusetts General Hospital, Kerry Reynolds, Massachusetts General Hospital, Rakesh Jain, Radiation Oncology,
Massachusetts General Hospital, Tomas neilan, Massachusetts General Hospital

Renin-Angiotensin-Aldosterone System Inhibitors and Survival in Patients with Ovarian Cancer Treated
with Immune Checkpoint Inhibitors
Submission ID 1311234
Background
The concurrent use of inhibitors of the renin–angiotensin–aldosterone system (RAAS) in patients with
gastrointestinal and genitourinary cancers treated with immune checkpoint inhibitors (ICIs) is associated
with improved mortality. There are limited data on the association between the use of RAAS inhibitors and
outcomes among patients with ovarian cancer treated with ICIs.
Method
We performed a retrospective study of all patients treated with an ICI in a single academic network. Of
10,903 patients, 5,910 were on any anti-hypertensive medication, of these 127 patients had ovarian cancer.
Of those ovarian cancer patients on anti-hypertensive therapy, 91 were prescribed a RAAS inhibitor during
ICI treatment and 36 were prescribed other anti-hypertensive medications. The primary outcome was overall
survival among patients with ovarian cancer.
Results
The median age among the cases (ovarian cancer on an ICI and RASS inhibitor) and controls (ovarian cancer
on an ICI and not on a RAAS inhibitor) were not different (65 [IQR: 57-70] vs. 64 [IQR: 55-70] years). Those
prescribed a RAAS inhibitor had a higher prevalence of diabetes (2.8% vs. 15%] P = .065) and hyperlipidemia
(19% vs. 45%, P = .007). Otherwise, cardiovascular risk factors were similar among the groups (Table). The
median overall survival was not different among the two groups (22.4 vs. 22.7 months, Figure). In a multivariable
Cox proportional hazard model (adjusted for age, body mass index, heart failure, diabetes, renal failure, liver
disease and smoking), the concurrent use of RAAS inhibitors was not associated with better overall survival
(HR:0.86, [95% CI:0.45-1.64], P = .65).
Conclusion
In this retrospective study, patients with hypertension who were concomitantly prescribed a RAAS inhibitor
during ICI therapy did not have a difference in overall survival as compared to those not on RAAS inhibitor.
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P 51
Authors
Rishi Patel, UT MD Anderson Cancer Center, Dominique Monlezun, UT MD Anderson Cancer Center, Cezar Iliescu, UT MD Anderson
Cancer Center, Jin wan Kim, The University of Texas Health Science Center at Houston, Jong Kun Park, UT McGovern School of Medicine,
Aamuktha Karla, UT McGovern School of Medicine, Kevin Honan, UT McGovern School of Medicine, Awad Javaid, Kirk Kerkorian School
of Medicine at UNLV, Nicolas Palaskas, UT MD Anderson Cancer Center, Mehmet Cilingiroglu, Laredo Physician Group, Konstantinos
Marmagkiolis, UT MD Anderson Cancer Center, Efstratios Koutroumpakis, UT MD Anderson Cancer Center
Management, Outcomes and Disparities in Patients with Cancer and Peripheral Vascular Disease
Submission ID 1311236
Background
Despite the growing co-prevalence, little is known about patients with active cancer and peripheral artery
disease (PAD) and indication for peripheral percutaneous transluminal angioplasty (PTA) including the latter’s
incidence, disparities, and outcomes.
Method
This is the first nationally representative multi-year study with AI and propensity score analysis utilizing the
United States’ largest all-payer hospitalized dataset, the 2016-2018 National Inpatient Sample (NIS). Machine
Learning-augmented Propensity Score adjusted multivariable regression (ML-PSr) was performed, confirmed
by deep learning neural networks with over 4 layers, weighted by the NIS complex survey design, and adjusted
for known confounders including mortality risk by DRG as calculated by the NIS along with the likelihood of
undergoing PTA.
Results
Among the 101,521,656 adult hospitalizations, there were 1,827,390 (0.18%) diagnosed with PAD of whom
159,030 (8.70%) underwent peripheral PTAs of which 9,924 (6.24%) were performed in patients with active
cancer. PTA volume among patients with cancer was largely constant from 2016 (6.01%) to 2017 (6.81%)
to 2018 (5.91%). Patients with versus without cancer were significantly less likely to have diagnosed PAD
(0.17% versus 0.18%, p=0.039). Among PTAs, the most common active malignancies included lung (30.86%),
leukemia (10.38%), and uterine (6.74%). In fully adjusted ML-PS regression, patients with versus without cancer
were significantly less likely to receive PTA (OR 0.70, 95%CI 0.64-0.76, p< 0.001), but among patients with
PTA, active cancer did not significantly increase mortality (OR 1.54, 95%CI 1.00-2.39, p=0.052), nor were there
any significant mortality disparities by sex, race, income, insurance, metro density, or region.
Conclusion
This AI and propensity score analysis of a nationally representative sample suggests that patients with active
cancer are less likely to receive PTA (controlling for their clinical severity) though there is comparable safety for
it, suggesting that PTA as evidence-based treatment may need to be extended to patients with cancer when
clinically indicated regardless of the cancer.
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P 52
Authors
Coleen Power, University Health Network- Toronto General Hospital/Ted Rogers Centre for Heart Research, Babitha Thampinathan,
University Health Network/Ted Rogers Centre for Heart Research, Eitan Amir, University of Toronto, Henry Su, University Health Network/
Ted Rogers Centre for Heart Research, Fernando Rivera Theurel, University Health Network/Ted Rogers Centre for Heart Research, Husam
Abdel-Qadir, Women’s College Hospital, Paaladinesh Thavendiranathan, University Health Network

Short Term Safety of Withdrawal of Cardiac Medications in Women with HER2+ Breast Cancer with
Recovered Cardiac Function Post Diagnosis of Cardiotoxicity
Submission ID 1311252

Background
Background: Cancer therapy related cardiac dysfunction (CTRCD) is usually treated with cardiac medications.
There is little consensus on whether this can be withdrawn if left ventricular (LV) function has recovered.
Objective: To determine if cardiac medications can be discontinued safely upon recovery of cardiac function
in women with HER2+ breast cancer with CTRCD during cancer therapy.
Method
Method:  We retrospectively identified women with HER2+ breast cancer treated with sequential anthracycline
and trastuzumab who were referred to our Cardio oncology program and were initiated on cardiac mediations
for CTRCD which were subsequently stopped in follow-up. Medications were stopped if LV ejection fraction
(LVEF) was normal or due to patient request. Echocardiography studies were analyzed for 2D LVEF and global
longitudinal strain (GLS); pre-cancer therapy, at the time of CTRCD, cessation of cardiac medications, and at
1-year follow-up with comparisons made using paired t-tests.
Results
Results: We identified 16 patients with a mean age of 51.1 ± 10.1 years who met our inclusion criteria. Cardiac
risk factors included: HTN (N&#3f2), diabetes (n=1), hypercholesterolemia (n=1), smoking (n=1). 2D-LVEF
(60.9 ± 2.8% vs 50.8 ± 4.1%, p< 0.001) and GLS (22.1 ± 2.1% vs 17.6 ± 1.6%, p< 0.001), both significantly
worsened pre-cancer therapy to CTRCD diagnosis. 14 patients had both beta-blocker and ACE inhibitor
stopped, a median of 20 (IQR 12-20) months form initiation. 2 patients continued ACE inhibitor alone due
to hypertension. At the time of medication cessation, the LVEF and GLS were 57.7 ± 3.3% and 20.6 ± 2.1%
respectively (p=0.07 and 0.03 versus baseline). At follow up (12 months, IQR 11-12 months) LVEF and GLS
were 60.7± 3.3% and 20.3% ±1.9% (p=0.80 and 0.008 vs baseline and 0.04 and 0.38 respectively vs time of
therapy cessation). None developed clinical heart failure over follow-up.
Conclusion
Conclusion: In these women with HER2+ breast cancer who received cardiac medications for CTRCD, these
medications were stopped once cardiac function recovered with no worsening of function in the short term.
Our work provides preliminary data to support a randomized trial to investigate the safety of cardiac medication
cessation after CTRCD.
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P 53
Authors
Pavithra Jayadeva, Toronto General Hospital, Maala Sooriyakanthan, Toronto General Hospital, Sudipta Saha, Toronto General Hospital,
Steve Fan, Toronto General Hospital, Paaladinesh Thavendiranthan, Toronto General Hospital

Whole Heart Remodelling During Cancer Therapy

Submission ID 1311258
Background
na
Objective:
To identify the impact of cancer therapy on all four cardiac chambers.
Introduction:
Identification of cancer therapy related cardiac dysfunction (CTRCD) has primarily focused on functional
changes to the left ventricle (LV).  There is limited knowledge on the impact of cancer therapy on the other
cardiac chambers.  
Method
This is a prospective cohort study of women with HER2+ early-stage breast receiving treatment with
anthracyclines followed by trastuzumab. Echocardiography was performed pre cancer therapy and 3 monthly
subsequently up to 15 months with the commencement of trastuzumab at 3 months. Echocardiography
measures included 2-dimensional (2-D) right (RA) and left atrial (LA) volumes and function (ejection fraction
and strain), left and right ventricular (RV) function and strain and 3D LVEF. LV .CTRCD was defined according
to the CREC Criteria.
Results
We included 136 patients (51.1 ±  9.2 years), of whom 37 (27%) developed LV CTRCD. LVEF, LV GLS, RV
free wall  strain, LA reservoir strain, LA ejection fraction and RA reservoir strain all reduced with treatment
with the changes beginning at 3 months with nadir reached at  6 months of trastuzumab therapy  (Figure
1).  All parameters exhibited a trend towards baseline by the end of therapy  however none completely
normalized. A total of 37 (27%) patients developed CTRCD, within this group LV GLS, RV free wall
strain, RV FAC, RA and LA reservoir strain differed between patients with and without LV CTRCD.
Figure 1: Temporal measurement of echocardiographic parameters of all cardiac chambers. LV GLS
= left ventricular peak longitudinal strain, LVEF = left ventricular ejection fraction, RV FAC= right
ventricular fractional area change, RV FW Str= right ventricular free wall strain, LA EF= left ventricular
ejection fraction, LA Res Str= Left atrial reservoir strain, RA res strain = right atrial reservoir strain.
Conclusion
Our study demonstrated worsening function of all 4 cardiac chambers during therapy with anthracyclines and
trastuzumab. This change was most pronounced at 6 months of trastuzumab therapy without complete return
to baseline. The potential impact of changes to all 4 chambers versus only changes to the left ventricle on
long term cardiovascular events warrants assessment.
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P 54
Authors
Jong Kun Park, UT McGovern School of Medicine, Dominique Monlezun, UT MD Anderson Cancer Center, Kevin Honan, UT McGovern
School of Medicine, Jin wan Kim, The University of Texas Health Science Center at Houston, Rishi Patel, UT MD Anderson Cancer Center,
Awad Javaid, Kirk Kerkorian School of Medicine at UNLV, Aamuktha Karla, UT McGovern School of Medicine, Nicolas Palaskas, UT MD
Anderson Cancer Center, Mehmet Cilingiroglu, Laredo Physician Group, Konstantinos Marmagkiolis, UT MD Anderson Cancer Center,
Cezar Iliescu, UT MD Anderson Cancer Center
Patent Foramen Ovale Closure Utilization, Disparities, Stroke, and Mortality in Cancer Patients: A
Nationally Representative Multi-year Study with Machine Learning and Propensity Score Analyses
Submission ID 1311261
Background
Patients with cancer historically have not been offered guideline-based procedures which may significantly
worsen their overall morbidity and mortality, yet little is known about the possible association between cancer
and patent foramen ovale (PFO) closures and post-closure cerebrovascular accidents (CVAs)
Method
This is the first machine learning and propensity score analysis closures by cancer and post-closure CVA in
a multi-year nationally representative dataset (the 2016-2018 National Inpatient Sample [NIS]), the largest
all-payer hospitalized dataset in the United States. Machine Learning-augmented Propensity Score adjusted
multivariable regression (ML-PSr) was utilized, confirmed by deep learning featuring neural networks with over
4 layers, weighted by the complex survey design for the NIS, and adjusted for known confounders (including
the NIS-calculated mortality risk by DRG and the likelihood of receiving closures)
Results
Of the 101,521,656 hospitalizations, there were 10,152 (0.01%) PFO closures of whom 727 (7.16%) had cancer.
Patients receiving closures were significantly less likely to have versus not have cancer (7.16% versus 92.84%).
The primary malignancies with the highest likelihood of receiving closures included: prostate (25.93%), breast
(14.81%), and non-melanoma skin (11.11%). Both patients with and without cancer had comparable likelihood
of suffering post-PFO CVA (22.22% versus 22.00%, p=0.979). There were no significant disparities in post-
closure CVA among patients with active cancer by sex, race, income, insurance, urban, or region. In full
adjusted ML-PS regression, cancer did not increase the odds of mortality or CVA (OR 0.55, 95%CI 0.17-
1.78, p=0.322), nor did metastatic cancer, nor did cancer overall in any sub-group analysis by age groups in
increasing 10-year intervals
Conclusion
This nationally representative analysis uses robust machine learning and propensity score analyses to suggest
that patients with cancer are significantly less likely to receive PFO closures despite it being safe compared
to patients without cancer, while pinpointing closure incidence by primary malignancies and confirming no
demographic disparities in post-closure CVA
_______________________________________________________________________________________

P 55
Authors
Alessandra Cuomo, Department of Translational Medical Science, University of Naples “Federico II”, Valentina Mercurio, Department
of Translational Medical Science, University of Naples “Federico II”, Manuela Pugliese, University of Naples Federico II, Maria Capasso,
Department of Pediatric Oncology Santobono-Pausilipon Hospital, Naples, Italy, serena ruotolo, Department of Pediatric Oncology
Santobono-Pausilipon Hospital, Naples, Italy, Anita Antignano, Department of Pediatric Oncology Santobono-Pausilipon Hospital,
Naples, Italy, Carlo Gabriele Tocchetti, Federico II University, Naples, Italy, and Center for Basic and Clinical Immunology Research (CISI),,
Annalisa Passariello, Inherited and Rare Cardiovascular Disease, Department of Translational Medical Sciences, University of Campania
“Luigi Vanvitelli”, Monaldi Hospital, Naples, Italy

Cardiovascular Events in Children Treated for High Risk Medulloblastoma

Submission ID 1311263

Background
Medulloblastoma is among the most frequent pediatric malignancies. Children with high-risk medulloblastoma
are treated with chemotherapeutic protocols, including high dose drugs, which may affect heart
function. Here, we aim at assessing cardiovascular events (CVE) in children undergoing oncological treatment
for medulloblastoma or primitive neuroectodermal tumors (PNET).
Method
We retrospectively collected data from children with high-risk medulloblastoma/PNET eligible for
chemotherapeutic treatment. Patients underwent cardiac examination, ECG, echocardiography and serum
biomarkers, before antineoplastic treatment and then when clinically needed. CVE occurrence was defined
by reduction of left ventricular ejection fraction (LVEF) >10% with a final LVEF< 50%, by the presence of new-
nosed cardiac arrhythmias and arterial hypertension.
Results
22 children, meeting the inclusion criteria, received Milan HART protocol for high-risk brain malignancies as
first line treatment, (except for 1 patient who received Milan HART as second line), followed by, if necessary,
radiation therapy directed to the brain. Patients who do not achieve complete remission before radiation
treatment are then administered with HD chemotherapy with thiotepa followed by hematopoietic stem
cell transplantation. Four patients also received second line treatment, while four patients also received
maintenance therapy.Six patients developed CVE (CVE group); 16 patients had no CVE (NO-CVE group).
In the CVE group, 3 patients presented acute CVE during chemotherapy (2 patients with LV dysfunction, 1
patient with arterial hypertension), while 3 patients presented chronic CVE after chemotherapy completion (2
patients with LV dysfunction, 1 patient with ectopic atrial tachycardia). After a 51 months median follow-up,
9 patients died: 4 from the CVE group (in 2 cases heart failure-related deaths) and 5 from the NO-CVE group
(progression of disease).
Conclusion
27% of children treated for medulloblastoma/PNET develops CVE. In particular, LV dysfunction due to
chemotherapy is among the most common manifestations of CVE (18%), and it may represent a cause of
death (9% mortality ). Hence, in these patients, strict cardiac surveillance is essential.
_______________________________________________________________________________________

P 56
Authors
Aamuktha Karla, UT McGovern School of Medicine, Dominique Monlezun, UT MD Anderson Cancer Center, Jong Kun Park, UT McGovern
School of Medicine, Kevin Honan, UT McGovern School of Medicine, Jin wan Kim, The University of Texas Health Science Center at
Houston, Rishi Patel, UT McGovern School of Medicine, Awad Javaid, Kirk Kerkorian School of Medicine at UNLV, Nicolas Palaskas,
UT MD Anderson Cancer Center, Mehmet Cilingiroglu, Laredo Physician Group, Konstantinos Marmagkiolis, UT MD Anderson Cancer
Center, Cezar Iliescu, UT MD Anderson Cancer Center

Mortality Disparities in Breast Cancer Concurrent with Acute Myocardial Infarction by National Regions:
Machine Learning with Deep Learning and Propensity Score Analysis of 2.53 Million Cases
Submission ID 1311266
Background
Socioeconomic disparities are prevalent and potentially preventable drivers of mortality differences among
patients with concurrent acute myocardial infarction (AMI) and breast cancer, which remains one of the most
common malignancies in females. However, a granular understanding of such disparities in these patients is
unclear.
Method
This nationally representative multi-year study with AI and propensity score analysis of the above associations
is the first known of its kind. It utilizes the United States’ largest all-payer hospitalized dataset, the 2016-
2018 National Inpatient Sample (NIS). Machine Learning-augmented Propensity Score adjusted multivariable
regression (ML-PSr) was performed, confirmed by deep learning neural networks with over 4 layers, weighted
by the NIS complex survey design, and adjusted for known confounders including mortality risk by DRG as
calculated by the NIS along with the likelihood of undergoing PCI.
Results
Of the 101,521,656 hospitalizations, there were 2,527,889 (2.49%) with breast cancer of whom 530,857
(21.03%) had active cancer. Patients with versus without active breast cancer were significantly less likely
to suffer an AMI (1.42% versus 2.10%, p< 0.001) but significantly more likely to receive PCI (36.30% versus
30.01%, p=0.005). In ML-PS regression among patients with breast cancer and AMI, mortality was significantly
increased for Hispanics (OR 1.71, 95%CI 1.08-2.72, p=0.022) and Asians (OR 2.19, 95%CI 1.10-4.34, p=0.025)
compared to Caucasians, but there were no income, insurance, or urban disparities nationally. In sub-group
analysis by region, there were significant mortality disparities for Hispanics in the New England region,
Hispanics in the Mid-Atlantic region, and the urban population in the South Atlantic region.  
Conclusion
This nationally representative AI and propensity score-based analysis highlights how persistent racial and urban
density disparities in breast cancer concurrent with AMI may be centered in particular regions, suggesting that
such granular analysis may assist healthcare system and policy modifications to prioritize equity efforts.
_______________________________________________________________________________________

P 57
Authors
Alessandra Cuomo, Department of Translational Medical Science, University of Naples “Federico II”, Valentina Mercurio, Department
of Translational Medical Science, University of Naples “Federico II”, Maria Roasaria Galdiero, Department of Translational Medical
Sciences, Federico II University, Naples, Italy, Francesca Rossi, Università degli Studi di Napoli Federico II, Gilda Varricchi, Department of
Translational Medical Sciences, Federico II University, Naples, Italy, Antonio Carannante, Department of Translational Medical Sciences,
Federico II University, Naples, Italy, Grazia Arpino, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy,
luigi formisano, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy, Roberto bianco, Department of
Clinical Medicine and Surgery, Federico II University, Naples, Italy, chiara carlomagno, Department of Clinical Medicine and Surgery,
Federico II University, Naples, Italy, carmine de angelis, Department of Clinical Medicine and Surgery, Federico II University, Naples,
Italy, mario giuliano, Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy, elide matano, Department of
Clinical Medicine and Surgery, Federico II University, Naples, Italy, marcopicardi, Department of Clinical Medicine and Surgery, Federico
II University, Naples, Italy, domenico salvatore, Department of Public Health, Federico II University, Naples, Italy, ferdinando, Department
of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy, erikamartinelli, Department of Precision Medicine, Luigi
Vanvitelli University of Campania, Naples, Italy, carminia Maria della corte, Department of Precision Medicine, Luigi Vanvitelli University of
Campania, Naples, Italy, floriana morgillo, Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy, michele
orditura, Department of Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy, Stefania napolitano, Department of
Precision Medicine, Luigi Vanvitelli University of Campania, Naples, Italy, teresa troiani, Department of Precision Medicine, Luigi Vanvitelli
University of Campania, Naples, Italy, Carlo Gabriele Tocchetti, Federico II University, Naples, Italy, and Center for Basic and Clinical
Immunology Research (CISI)

Impact of a Cardio-oncology Unit on Prevention of Cardiovascular Events in Cancer Patients

Submission ID 1311269
Background
Here, we describe the impact of a large cardio-oncology unit in Southern Italy, characterizing different types
of patients and discussing challenges in therapeutic management of cardiovascular complications.
Method
We enrolled 231 consecutive patients referred to our cardio-oncology unit from January 2015 to February
2020. Three different types were identified, according to their chemotherapeutic statuses at first visit. Type
1 included patients naïve for oncological treatments, Type 2 patients already being treated with oncological
treatments, and Type 3 patients who had already completed cancer treatments. Each type was also divided in
subgroup a (patients with no cardiovascular risk factors or well-controlled cardiovascular risk factors at the time
of the first cardiological assessment) and subgroup b (patients with uncontrolled cardiovascular risk factors or
over cardiovascular diseases at the time of the first cardiological assessment). Clinical outcomes were defined
as: cardiovascular events during antineoplastic treatments, temporary suspension or change in oncological
treatments due to cardiovascular complications, cancer treatment permanent withdrawal, death for all causes.
Also, cardiovascular treatment optimization and the prescription of new cardiovascular drugs were analyzed.
Results
Type 2 patients presented the highest incidence of cardiovascular events (46.2% vs. 12.3% in Type 1 and
17.9% in Type 3) and withdrawals from oncological treatments (5.1% vs. none in Type 1) during the observation
period. Type 2 patients presented significantly worse 48 months of survival (32.1% vs. 16.7% in Type 1 and
17.9% in Type 3), and this is more evident when in the three groups we focus on patients with uncontrolled
cardiovascular risk factors or overt cardiovascular disease at the first cardiological assessment. Nevertheless,
patients in subgroups b for each type showed the greatest benefit from our cardiovascular assessments, as
witnessed by a small, but significant improvement in ejection fraction during follow-up.
Conclusion
Patients who start oncological protocols without an accurate baseline cardiovascular evaluation are at major
risk of developing cardiac complications due to antineoplastic treatments.
_______________________________________________________________________________________

P 58
Authors
Jong Kun Park, UT McGovern School of Medicine, Dominique Monlezun, UT MD Anderson Cancer Center, Kevin Honan, UT McGovern
School of Medicine, Jin wan Kim, The University of Texas Health Science Center at Houston, Rishi Patel, UT MD Anderson Cancer Center,
Awad Javaid, Kirk Kerkorian School of Medicine at UNLV, Aamuktha Karla, UT McGovern School of Medicine, Nicolas Palaskas, UT MD
Anderson Cancer Center, Mehmet Cilingiroglu, Laredo Physician Group, Konstantinos Marmagkiolis, UT MD Anderson Cancer Center,
Cezar Iliescu, UT MD Anderson Cancer Center
Outcome and Cost Impact of Disparities in Watchman Implantation in Cancer Patients: Multi-year
Nationally Representative Study Using Machine Learning and Propensity Score Analyses
Submission ID 1311331
Background
Watchman implantations (WIs) are increasing, yet utilization, outcome, and cost disparities are largely unknown
among patients with cancer (an increasing sub-group of WI candidates), including if institutional procedural
volume improves the above
Method
This is the first nationally representative multi-year analysis, including the first with machine learning and
propensity score analysis, to assess the above associations. It uses the 2016-2018 National Inpatient Sample
(NIS) which is the largest all-payer hospitalized United States dataset. Analyses featured Machine Learning-
augmented Propensity Score adjusted multivariable regression (ML-PSr), confirmation by deep learning
neural networks with over 4 layers, weighting by the NIS complex survey design, and controlling for known
confounders including mortality risk by DRG as calculated by the NIS in addition to the likelihood of undergoing
WI
Results
Of the 101,521,656 hospitalizations, there were 20,304 (0.02%) WIs of whom 3,478 (17.13%) were done
in patients with cancer. Patients with versus without cancer had comparable likelihood of post-procedural
complications (1.09% versus 1.47%, p=0.694) and inpatient mortality (0.00% versus 0.34%, p=0.430). The most
common variables significantly associated (p< 0.05) with complications were being female, obese, non-white,
and having chronic obstructive pulmonary disease. In ML-PS regression, among hospital tertiles categorized
by Watchman procedural volume, there was no significant association between hospital volume tertiles
and mortality nor complications. Among patients with cancer, Hispanics were significantly more likely than
Caucasians to have complications (OR 8.37, 95%CI 1.13-62.05; p=0.038) and increased total hospitalization
costs ($27,868.73, p=0.009, but no other demographic disparities existed for complications, mortality, or cost
Conclusion
This machine learning and propensity score-enabled nationally representative study supports that WI
procedural volume does not appear to improve outcomes, though reducing persistent racial disparities may.
Persistent disparities in post-procedural complications for Hispanics versus Caucasians alone may cost the US
healthcare system $47.33 million annually in potentially preventable expenses
_______________________________________________________________________________________

P 59
Authors
Prince Otchere, UT Health San Antonio Cardio-Oncology Center of Excellence/Harvard T.H. Chan School of Public Health, Olusola
Adekoya, Kettering Health Network, Samuel Governor, Saint Louis University, Biostatistics Department, Naveen Vupuluri, Kettering
Health Network, Akruti Prabhakar, Wright State University, Oduro Oppong-Nkrumah, McGill University, Francis Cook, Harvard T.H. Chan
School of Public Health

Development of Cardiac Risk Prediction Model in Patients with HER-2 Positive Breast Cancer on
Trastuzumab Therapy
Submission ID 1311341
Background
25% of all breast cancer patients have HER-2+ overexpression. Breast cancer with HER-2+ overexpression is
typically treated with HER-2+ inhibitors such as Trastuzumab. Trastuzumab is known to cause a decrease in
left ventricular ejection fraction. The aim of this study is to create a cardiac risk prediction tool among women
with Her-2+ breast cancer to predict cardiotoxicity.
Method
Using a split sample design, we created a risk prediction tool using patient-level data from electronic medical
records. The study included women 18 years of age and older diagnosed with HER-2+ breast cancer who
received Trastuzumab. The outcome measure was defined as a drop in LVEF by more than 10% to less than
53% at any time in the 1-year study period. Logistic regression was used to test predictors.
Results
Our model had an area under the curve (AUC) of 64%. The accurate prediction of our model was 80% with
95% CI (73% - 86%). Test sensitivity was 46% and specificity was 84%. The positive predictive value of cardiac
dysfunction in our study was 22%, and the negative predictive value was 94%. In this regard, we have shown that
91% of the women do not develop cardiotoxicity within a year of follow-up. With a negative predictive value of
94%, the probability of not experiencing cardiotoxicity in 12 months given a negative result by our model is 94%.
 
With our model, we hope to identify women who are at high risk of developing cardiotoxicity from those
who are not at increased risk for cardiotoxicity. This way, high-risk women for cardiotoxicity can be screened
more frequently and perhaps according to the current practice of imaging patients every 3 months, whereas
the low-risk women can be screened less frequently. This approach has a more appealing cost-effectiveness
profile while being safe.
Conclusion
Test characteristics in addition to disease prevalence my inform a rational strategy in preforming
cardiac ultrasound in Her-2+ breast cancer patients. We have developed a cardiac risk prediction
model with high NPV in a low-risk population which has an appealing cost-effectiveness profile.
Future studies using a cost-effectiveness analysis design may determine optimal imaging intervals in low-risk
patients.
_______________________________________________________________________________________

P 60
Authors
Nino Sharashidze, Ivane Javakhishvili Tbilisi State University, Nino Lomia, Ivane Javakhishvili Tbilisi State University, Maia Kereselidze,
National Center for Disease Control and Public Health, Lela Sturua, National Center for Disease Control and Public Health, Dimitri
Kordzaia, Ivane Javakhishvili Tbilisi State University, Tea Chitadze, Ivane Javakhishvili Tbilisi State University, Maia Tsiklauri, Ivane
Javakhishvili Tbilisi State University, Giorgi Saatashvili, Ivane Javakhishvili Tbilisi State University

Cardiovascular Causes of Death in Breast Cancer Patients: Georgia Cancer Registry 2020-2021
Submission ID 1311346
Background
Increased cardiovascular disease (CVD) mortality in breast cancer (BC) patients previously was reported.
Several mechanisms related both with cancer and anticancer therapies have been linked to CVD
complications. Objective: We aimed to assess CV causes of death (COD) in BC patients who underwent
anticancer drug treatment and/or radiotherapy.
Method
The CVD-related COD and other significant contributing diagnoses in 522 BC patients who died during
January 1, 2020 – January 1, 2021 and retrieved from the Georgia Cancer Registry database were analyzed.
The majority of patients (344, 65.9%) underwent some type of anticancer treatment: chemotherapy (24.5
%), hormone therapy (7.1%), radiotherapy (11.9%), and combined treatment (22.4%). The frequencies and
proportions of CVD deaths were calculated in this subgroup by specific causes and age groups. Proportions
were compared using the Pearson’s chi-square test.
Results
 Of a total of 344 BC patients who underwent any type of treatment, 52 (15.1%) deaths were attributed to
CVD. Specific CV causes included: ischemic heart disease (myocardial infarction and sudden cardiac death,
19 cases (36.5%)), dilated cardiomyopathy (2, 3.8%), pulmonary embolism (6, 11.5%) and cerebrovascular
events (10, 19.2%). Overall, heart failure (HF) was diagnosed in 23 patients (6.7%), including unspecified HF (5,
1.5%). Arterial hypertension (9, 2.6%,), valvular heart disease (3, 0.9%), and atrial fibrillation (2, 0.6%) were the
most common conditions contributing death. The highest percentage (24.3%) of CVD deaths was reported in
young women (25-49 years), followed by 50-70-year- and older age groups (14.1% and 13.9%, respectively,
p>0.05).   
Conclusion
CVD was a common COD in BC patients who underwent anticancer treatment. Heart Failure was one of the
most frequently diagnosed heart condition.  Importantly, cardiotoxicity related cardiomyopathy (I42.7, ICD
10), considered one of the main causes of HF in treated BC patients, was not reported either as a CVD COD
or a significant contributing condition in the Georgia Cancer Registry data. Underdiagnosis of cardiotoxicity
and related cardiomyopathy may lead to inadequate CVD prevention and treatment in affected individuals.
_______________________________________________________________________________________

P 61
Authors
Stephen Foulkes, Baker Heart and Diabetes Institute, Lauren Burnham, Baker Heart and Diabetes Institute, Steve Fraser, Deakin University,
Robin Daly, Deakin University, Andre La Gerche, Baker Heart and Diabetes Institute, Erin Howden, Baker Heart and Diabetes Institue

Feasibility and Efficacy of Telehealth versus Gym-based Rehabilitation in Breast Cancer Survivors
Undergoing Cardiotoxic Chemotherapy: Secondary Analysis of a Randomised Trial
Submission ID 1311386
Background
Supervised gym- and telehealth-based exercise rehabilitation are gaining interest as an adjunct therapy for
breast cancer survivors (BCS) undergoing cardiotoxic chemotherapy, however there is limited evidence on the
comparative feasibility and efficacy of these approaches. This study compared the feasibility and efficacy of
12-weeks of gym- and telehealth-based rehabilitation in BCS undergoing anthracycline chemotherapy.
Method
This was a secondary analysis of BCS undergoing chemotherapy (n=20) who participated in a thrice-weekly
12-week exercise intervention delivered by exercise physiologists between November 2017 and January 2021
as part of a broader study. Participants who undertook the intervention via telehealth during the COVID-19
pandemic (n=10) were compared to participants matched for age (±3 years) and treatment intensity who
undertook the intervention in the supervised gym setting (n=10). Adherence, and changes in anthropometry
(weight, waist circumference), cardiorespiratory fitness (VO2peak), muscular strength (grip strength, leg press
1 repetition max [1RM]) and physical function (timed stair climb, 30 second sit-to-stand [30STS]) from baseline
to the end of the intervention were compared between approaches.
Results
Mean (±SD) exercise adherence was similar between groups (Gym: 82±14% vs Telehealth: 84±10%, P=0.73).
Compared to gym-based group, telehealth was associated with similar changes in anthropometry, VO2peak,
strength and stair climb performance (P >0.05 for all). However, the gym-based group showed a 27% greater
mean improvement in 30STS (95% CI: 11 to 43%, P=0.001).  
Conclusion
Remote exercise prescription by telehealth is a feasible rehabilitation approach for BCS undergoing cardiotoxic
chemotherapy with comparable efficacy to gym-based rehabilitation.
_______________________________________________________________________________________

P 62
Authors
Anna Narezkina, University of California San Diego Health, Nausheen Akhter, Northwestern Medicine, Xiaoxiao Lu, Janssen Scientific
Affairs, Bruno Emond, Analysis Group, Inc., Sumeet Panjabi, Janssen Scientific Affairs, Shaun P. Forbes, Analysis Group, Inc, Annalise
Hilts, Analysis Group, Inc, Stephanie Liu, Analysis Group, Inc, Marie-Hélène Lafeuille, Analysis Group, Inc, Patrick Lefebvre, Analysis
Group, Inc., Qing Huang, Janssen Scientific Affairs, Michael Y Choi, 6University of California San Diego Moores Cancer Center

Real-World Persistence and Time to Next Treatment with Ibrutinib in Patients with Chronic Lymphocytic
Leukemia/Small Lymphocytic Lymphoma Including Patients at High Risk for Atrial Fibrillation or Stroke
Submission ID 1311397
Background
Atrial fibrillation (AF) is a recognized adverse consequence associated with all Bruton’s tyrosine kinase inhibitors
used to treat chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL); however, real-world time
to discontinuation (TTD) and time to next treatment (TTNT) of CLL/SLL patients with a high baseline AF/stroke
risk remain unknown.
Method
Patients with CLL/SLL from a nationwide electronic health record-derived database (02/12/2013–01/31/2021)
initiating first-line (1L) or second or later-line (2L+) treatment with ibrutinib or other regimens on or after
02/12/2014 (index date) were analyzed. Kaplan–Meier survival analysis was used to assess TTD and TTNT
among all patients, patients with high AF risk (CHARGE-AF risk score ≥10.0%), and patients at high risk of
stroke (CHA2DS2-VASc risk score ≥3 [females] or ≥2 [males]).
Results
In 1L/2L+, 2,190/1,851 patients received ibrutinib and 4,388/4,135, were treated with other regimens. Median
TTD for ibrutinib was similar regardless of AF/stroke-related risk (1L: all patients, 20.0 months; high AF risk,
15.7 months; high stroke risk, 18.0, 11.7 months; similar results in 2L+). Median TTNT was significantly longer
for ibrutinib vs. other regimens (1L: not reached vs. 45.9 months; 2L+: not reached vs. 23.6 months; both P<
0.05), including among those with high AF/stroke risk. TTNT was similar between all patients and high-risk
cohorts in 1L and 2L+ (all P >0.05).
Conclusion
This study highlights that elevated baseline AF/stroke-related risk does not adversely impact TTD and TTNT
outcomes associated with ibrutinib use. Additionally, TTNT was significantly longer for patients treated with
ibrutinib vs. other regimens.
_______________________________________________________________________________________

P 63
Authors
Nino Lomia, Ivane Javakhishvili Tbilisi State University, Nino Sharashidze, Ivane Javakhishvili Tbilisi State University, Maia Kereselidze,
National Center for Disease Control and Public Health, Lela Sturua, National Center for Disease Control and Public Health, Dimitri
Kordzaia, Ivane Javakhishvili Tbilisi State University, Tea Chitadze, Ivane Javakhishvili Tbilisi State University, Maia Tsiklauri, Ivane
Javakhishvili Tbilisi State University, Giorgi Saatashvili, Ivane Javakhishvili Tbilisi State University

Cardiovascular Outcomes in Breast Cancer Patients with Different Anti-Cancer Therapeutic Regimens:
Georgia Cancer Registry 2020-2021
Submission ID 1311431
Background
The available evidence indicates an excess risk of cardiovascular events in breast cancer (BC) patients.
Anticancer treatment related cardiotoxicity has been suggested as of the main contributors of increased CVD
mortality. The aim of the presented study was to examine the impact of the different anticancer treatment
strategies on CVD mortality risk.
Method
The CVD-related mortality in 366 patients diagnosed with stage l-III BC who died during January 1, 2020
– January 1, 2021 and retrieved from the Georgia Cancer Registry database were analyzed. Overall, 232
(63.4%) women underwent some type of anticancer treatment including chemotherapy (21.9 %), hormone
therapy (19.9%), or radiotherapy (11.9%). Proportions were compared using the Pearson’s chi-square test.
Univariate and multivariate logistic regression models were then fitted to explore the association between
different anticancer treatment regimen and CVD mortality, measured by crude and adjusted odds ratios with
corresponding 95% confidence intervals (COR and AOR, 95% CI).
Results
Of a total of 366 BC patients, included in the analysis, CVD accounted for 65 (17.8%) deaths. Among these
patients, the majority (56.9%) were women who underwent any type of anticancer treatment (p< 0.05).
Univariate logistic regression analysis revealed that, compared to untreated women, those who underwent
hormone therapy had a statistically significant higher risk of CVD mortality (COR 3.59, 95%CI 1.32-9.76,
p=0.012), which slightly increased after adjustment for age (AOR 3.61, 95%CI 1.33-9.80, p=0.012). There were
no significant differences in CVD mortality risk between women who underwent other anticancer treatment
and those who were untreated
Conclusion
 Hormone containing anticancer regimens in BC patients are associated with the significantly increased risk
of CVD mortality.
_______________________________________________________________________________________

P 64
Authors
Alexandra Murphy, Austin Health, Anoop Koshy, Austin Health, Omar Farouque, Austin Health, Belinda Yeo, Austin Health, Ron Dick,
Epworth Richmond, Voltaire Nadurata, Bendigo Health, Laura Roccisano, Austin Health, Matias Yudi, Austin Health

SMARTphone-Based Cardiovascular Risk Reduction in BREAST Cancer Patients [SMART-BREAST]: A

Randomized Controlled Trial
Submission ID 1282446
Background
Breast cancer survivors are at greater risk for cardiovascular-related mortality compared to women without
breast cancer. Attention to reducing the risk of heart disease must be a priority in the long-term management
of these patients.
Method
Patients with breast cancer across four tertiary Australian hospitals were screened for inclusion in this
randomized controlled trial. Patients were randomized to standard care (SC), with or without an adjunctive
smartphone application ‘BreastMate’ (SP) at time of diagnosis. The primary endpoint was change in exercise
capacity, measured by the change in six-minute walk test (6MWT) distance at 12-months when compared to
baseline, between groups. Secondary endpoints included changes in cardiovascular risk factors, psychological
wellbeing, and major adverse cardiovascular events (MACE).
Results
Of the 103 patients recruited, complete follow-up data was available in 80 (77.7%) (age 60±12 years, SP=41,
SC=39). At 12-months follow-up, the SP group had a statistically and clinically significant improvement in
6MWT distance (Median Δ46 (IQR 28 to 63) metres vs. Δ8 (-10 to 35) metres; p< 0.001). Compared to SC,
patients in the SP group had a greater reduction in systolic blood pressure (Δ-5.1 (-10 to 0) vs 0 (-10 to
7) mmHg; p=0.03) and waist circumference (Δ-1 (-4 to 0) vs 0 (-1.5 to 1)cm; p=0.003) as well as a greater
improvement in vitality as measured by the sf-36 questionnaire (48.1 ± 18.4 to 63.3±19.2 vs 48.3 ± 24.2
to 59.6±18.8; p=0.04). There was no significant difference in cholesterol levels, diabetes control, smoking
cessation or incidence of MACE between groups (p-value for all=NS).
Conclusion
In patients with breast cancer, a smartphone-based cardiovascular risk reduction program, as an adjunct to
standard care, improved exercise capacity, systolic blood pressure, waist circumference and patient-reported
vitality at 12-months. This innovative model of care could be implemented to improve the cardiovascular risk
profile of breast cancer
_______________________________________________________________________________________

P 65
Authors
Muhummad Sohaib Nazir, Royal Brompton Hospital, Joseph Okafor, Royal Brompton Hospital, Theodore Murphy, Royal Brompton
Hospital, Maria Andres, Royal Brompton Hospital, Sivatharshini Ramalingham, Royal Brompton Hospital, Stuart Rosen, Royal Brompton
Hospital, Amedeo Chiribiri, King’s College London, Sven Plein, King’s College London, Sanjay Prasad, Royal Brompton Hospital, Raad
Mohiaddin, Royal Brompton Hospital, Dudley Pennell, Royal Brompton Hospital, Rajdeep Khattar, Royal Brompton Hospital, John Baksi,
Royal Brompton Hospital, AlexanderLyon, Royal Brompton Hospital

LVEF Measured with Same Day Echocardiography and CMR in Patients with Suspected Cardiotoxicity
Submission ID 1304158
Background
Left ventricular ejection fraction (LVEF) is widely used for assessment of cardiotoxicity in cancer patients.
Cardiovascular Magnetic Resonance (CMR) is the reference standard for LVEF assessment, but echocardiography
is most widely used. This study sought to compare LVEF measured by echocardiography and CMR in cancer
patients with suspected cardiotoxicity.
Method
745 patients underwent same day imaging with echocardiography and CMR. Cases with suboptimal image
quality and those in whom 2D Biplane Simpson’s method could not be performed were excluded. A sub-set
(n=74) also had 3D echocardiography derived LVEF. Agreement was determined by Bland-Altman analysis.

Results
Mean age of patients was 60±5 years, of whom 62% were female. 2D echocardiography LVEF was significantly
lower compared to CMR, (median 60% [interquartile range 54-65%]) vs 63% [interquartile range 56-69%],
p< 0.001). Using Bland-Altman analysis, mean bias was -3.7±7.6% (95% limits of agreement [LOA] -18.5 to
11.1%) of 2D echocardiography versus CMR derived LVEF. In 74 patients in whom CMR, 3D echocardiography
and 2D echocardiography were performed, LVEF was 60.0±10.4%, 58.4±9.4% and 57.2±8.9%, respectively
(p=0.0006). There was better agreement with 3D echocardiography and CMR derived LVEF (mean bias of
-1.6±6.3 [95% LOA -13.9 to 10.7%]) compared to 2D echocardiography and CMR derived LVEF (mean bias of
-2.8±6.3 [95% LOA-15.2 to 9.6%]), (p=0.02).
Conclusion
2D echocardiography and CMR derived LVEF are not interchangeable. 2D echocardiography has variations
of ±15% compared to CMR. 3D echocardiography has better agreement with CMR derived LVEF and should
be used for assessment of cardiotoxicity.
_______________________________________________________________________________________

P 66
Authors
Elissa A. S. Polomski, Leiden University Medical Center, Julius Heemelaar, Leiden University Medical Center, Augustinus D.G. Krol, Leiden
University Medical Center, Marloes Louwerens, Leiden University Medical Center, Michiel A. de Graaf, Leiden University Medical Center,
J. Wouter Jukema, Leiden University Medical Center, Martin J. Schalij, Leiden University Medical Center, Louisa Antoni, Leiden University
Medical Center

Hodgkin Lymphoma Patients Treated with Radiotherapy Are at Risk of Elevated Coronary Artery Calcium
Score: A Matched Case-control Study
Submission ID 1304440
Background
Long-term survival after Hodgkin lymphoma (HL) has improved significantly over the past years, due to
improved treatment options. Thoracic radiotherapy is one of the corner stones of HL treatment, but is
associated with increased risk of cardiovascular events. As HL is often diagnosed at a young age, long-term
follow-up including screening for coronary artery disease is recommended. This study aims to evaluate if
Hodgkin lymphoma patients treated with radiotherapy are at higher risk of developing elevated coronary
artery calcium score (CACS) and whether this is associated with increased risk of future cardiovascular events.

Method
Consecutive HL patients treated with radiotherapy, who underwent evaluation for asymptomatic coronary
artery disease between 2002 and 2019 were included. CACS was performed > 10 years after HL irradiation.
91 HL patients were matched to 91 noncancer patients regarding gender, age and cardiovascular risk factors.
Patients with prior cardiovascular events were excluded from analysis. The odds ratio (OR) of having elevated
CACS (defined as > 0) was calculated for the HL patient group vs. the noncancer patient group. Also, in the
HL patient group, Cox regression was performed for the composite outcome, consisting of cardiac death
and cardiovascular events (acute coronary syndrome (ACS), percutaneous coronary intervention (PCI) and
coronary artery bypass grafting (CABG)).
Results
This matched study population consisted of 182 patients with a median age of 45.7 [p25;p75 = 37.6;52.1]
years at baseline visit. 118 patients (64.8%) were female. A CACS > 0 was found in 47 (41.7%) HL patients and
27 (29.7%) noncancer patients. The OR for having a CACS > 0 for HL patients treated with radiotherapy vs.
noncancer patients was 2.53 [95% CI: 1.38-4.64]. The median follow-up of the HL patients was 8.1 [5.0;9.5]
years since CACS, in which 13 patients (14.3%) experienced the composite outcome. Adjusted for gender
and age at diagnosis, a CACS > 0 was significantly related with cardiovascular events during follow-up (hazard
ratio = 3.63 [1.02-21.07], p = 0.047).
Conclusion
This study shows that a in a matched study population, a CACS > 0 is more often present in HL survivors
10 years after irradiation. Also, elevated CACS was significantly associated with increased risk of future
cardiovascular events and cardiac death in HL survivors.
_______________________________________________________________________________________

P 67
Authors
Muhummad Sohaib Nazir, Royal Brompton Hospital, Theodore Murphy, Royal Brompton Hospital, Nana Poku, Royal Brompton Hospital,
Peter Wheen, Royal Brompton Hospital, Alex Nowbar, Royal Brompton Hospital, Maria Andres, Royal Brompton Hospital, Sivatharshini
Ramalingham, Royal Brompton Hospital, Stuart Rosen, Royal Brompton Hospital, Edward Nicol, Royal Brompton Hospital, Alexander
Lyon, Royal Brompton Hospital

Clinical Utility and Prognostic Value of Cardiac CT Angiography in Cancer Patients

Submission ID 1304557
Background
There is much interest in the role of Cardiovascular Computed Tomographic Angiography (CCTA) in cardio-
oncology patients. However, there is a paucity of real-world experience and outcome data for these patients.
The objective of this study was to determine the clinical utility and prognostic value of CCTA in cancer
patients referred for cardio-oncology assessment.
Method
In this prospective single center study, we recruited patients referred for cardio-oncological assessment who
underwent CCTA as part of clinical care. Coronary artery disease (CAD) extent was classified as normal,
non-obstructive (1-49% stenosis), and obstructive (≥50% stenosis). Patients were followed up for a median
12 months (interquartile range 3-32) for major adverse cardiovascular events (MACE) defined as non-fatal
myocardial infarction or urgent unplanned revascularization.
Results
107 patients, mean age 61±12 and 63 (58%) female, 99 underwent a CCTA for native vessels. The most
common underlying cancers were breast (28%) and lymphoma (11%). 23 patients had obstructive CAD, most
commonly of the left anterior descending artery. Following CCTA, 87% statin-naïve patients with potentially
obstructive CAD were initiated on statin therapy. 18/23 patients that were taking fluoropyridine chemotherapy
(5-Fluorouracil or capecitabine) were able to continue therapy, of which none had MACE. Overall, in all
patients, we found a low 1-year risk of MACE of 1.8%.
Conclusion
CCTA has an important role in cancer patients to detect CAD, initiate primary preventative therapy, and guide
revascularization. A low incidence of MACE was observed and using this CCTA guided approach allowed
subsequent initiation of therapy, and most patients were able to continue prognostically important cancer
therapy.
_______________________________________________________________________________________

P 68
Authors
Yusuf Ziya ŞENER, Beypazarı State Hospital, Cardiology Department, Gürkan GÜNER, Hacettepe University Faculty of Medicine, Medical
Oncology Department, Serkan AKIN, Hacettepe University Faculty of Medicine, Medical Oncology Department, Uğur CANPOLAT,
Hacettepe University Faculty of Medicine, Cardiology Department, Mehmet Ruhi ONUR, Hacettepe University Faculty of Medicine,
Radiology Department, Sercan AKSOY, Hacettepe University Faculty of Medicine, Medical Oncology Department, Ömer DİZDAR,
Hacettepe University Faculty of Medicine, Medical Oncology Department

Effects of Sarcopenia on Anthracycline Related Right Ventricular Cardiotoxicity

Submission ID 1304749
Background
Anthracycline cardiotoxicity is the hallmark of Cardio-Oncology subspecialty and studies in the literature are
focused on the left ventricular toxicity. Sarcopenia is reported to be associated with anthracycline cardiotoxicity.
We aimed to evaluate effects of sarcopenia on anthracycline related right ventricular cardiotoxicity.
Method
Consecutive cancer patients who received anthracycline were followed with transthoracic echocardiography.
Sarcopenia was defined as a low skeletal muscle index measured at the level of L3 vertebra on abdominal CT
images. ESMO definition of anthracycline cardiotoxicity was preferred in the study.
Results
A total of 52 patients were enrolled. Median age of the population was 46 (18-71) years and 78.8 of
the cases (n=41) were female. The most common cancer was breast cancer (n=32) and 12 patients had
lymphoma. Mean follow-up was 7.1 ± 3.3 months. Baseline characteristics were presented in Table-1.
Anthracycline cardiotoxicity developed in 4 (7.6 %) cases and it was significantly higher in patients with
sarcopenia (23.1% vs 2.6%, p=0.044). Changes in right ventricular parameters during follow-up was measured
and sarcopenic cases were compared with non-sarcopenic patients. Although decrease in TAPSE and RV S
wave were higher in sarcopenic patients, these differences did not reach statistical significance. Increase in
RV end-diastolic diameter was also higher in sarcopenic cases than non-sarcopenic counterparts. There was
also not difference about changes in right ventricular fractional area change and right ventricular outflow
shortening fraction during follow-up (Table-2).
Conclusion
Anthracycline cardiotoxicity defined according to ESMO definition is distinctly higher in sarcopenic cases.
However, although deterioration of some right ventricular systolic function parameters after anthracycline
treatment is worse in sarcopenic patients, it is not statistically significant. Large volume prospective studies
are needed to clarify this relationship.
_______________________________________________________________________________________

P 69
Authors
Beatriz Silva, Centro hospitalar Lisboa norte, Andreia Magalhães, Centro hospitalar lisboa norte, Miguel Menezes, Centro hospitalar
lisboa norte, Mariana Saraiva, Hospital do Barreiro, Paula Costa, centro hospitalar lisboa norte, Fausto Pinto, Centro hospitalar Lisboa
norte, Manuela Fiuza, Centro hospitalar Lisboa Norte

Predictors of Cardiotoxicity in Patients with Breast Cancer: A Prospective Study

Submission ID 1311215
Background
Cardiotoxicity (CTX) is a well-stablished side effect of antineoplastic drugs. Ejection fraction (EF) is not a good
predictor of CTX as it does not detect early myocardial changes. Left ventricular global longitudinal strain
(GLS) and biomarkers - both classical (troponin, NTproBNP) and emerging (such as galectin) - have been
proposed, but its application remains ill-defined. This study aimed to evaluate predictors of CTX in patients
(pts) with breast cancer submitted to chemotherapy (QT).
Method
Prospective single centre study of female pts with breast cancer and normal EF (≥55%) who underwent QT
(with or without radiotherapy). Pts were included between 2012 and 2017 and were submitted to a clinical,
laboratory and echocardiographic evaluation at baseline and 1,3,6,9, 12 and 24 months of follow-up and in
2021. CTX was defined as a reduction of ≥10% in EF in the setting of an EF < 55% (1st endpoint) or as reduced
EF alone (2nd endpoint). Mann-Whitney and receiver operator curves were used for statistical analysis.
Results
A total of 134 female pts were included (mean age 52 + 12 years; 27% hypertension, 17% smoking and 15%
dyslipidemia). Mean follow-up as 7+2 years). Cancer therapy included anthracycline (84%), cyclophosphamide
(94%), placitaxel (57%), docetaxel (34%) and trastuzumab (34%).The 1st and 2nd endpoints occurred in 5%
and 9% of pts, respectively. The reduction of GLS in the 1st month was a predictor of decreased EF (OR 10,
95%CI 1.1-90, p=0.04). The cutoff value of -19% for GLS showed  the best sensibility-specificity ratio. An
abnormal GLS (< -19%) in 1st month predicts the long-term reduction in EF (p=0.014). GLS evaluated at 6 and
9 months was significantly lower in pts who achieved the 1st endpoint (p=0.011) and predicted CTX (p=0.048,
OR:1.57; and p=0.025, OR:0.19, respectively).NTproBNP at 1 st and 6th months were significantly higher in
pts who achieved 1st endpoint (86 vs 323 and 80 vs 328 pg/ml; p=0.001). Troponin at 1,3,6 and 9 months was
significantly higher in pts with both 1st and 2nd endpoints (p< 0.001). Pts with reduced EF at follow-up had
higher galectin levels at baseline and 1st month (p=0.043).
Conclusion
Our study supports the use of deformation imaging and biomarkers for the early detection of CTX.
_______________________________________________________________________________________

P 70
Authors
Magdalena Zaborowska-Szmit, Maria Sklodowska-Curie National Research Institute of Oncology, Sebastian Szmit, CMKP, Marta Olszyna-
Serementa, Maria Sklodowska-Curie National Research Institute of Oncology, Katarzyna Zajda, Maria Sklodowska-Curie National
Research Institute of Oncology, Paweł Badurak, Maria Sklodowska-Curie National Research Institute of Oncology, Piotr Jaśkiewicz, Maria
Sklodowska-Curie National Research Institute of Oncology, Anna Janowicz - Żebrowska, Maria Sklodowska-Curie National Research
Institute of Oncology, Aleksandra Piórek, Maria Sklodowska-Curie National Research Institute of Oncology, Magdalena Knetki-
Wróblewska, Maria Sklodowska-Curie National Research Institute of Oncology, Adam Płużański, Maria Sklodowska-Curie National
Research Institute of Oncology, Kinga Winiarczyk, Maria Sklodowska-Curie National Research Institute of Oncology, Sylwia Tabor, Maria
Sklodowska-Curie National Research Institute of Oncology, Borucka Borucka, Maria Sklodowska-Curie National Research Institute of
Oncology, KowalskiKowalski, Maria Sklodowska-Curie National Research Institute of Oncology, Maciej Krzakowski, Maria Sklodowska-
Curie National Research Institute of Oncology

All-cause Mortality in Patients with Cardiovascular Diseases and Locally Advanced Unresectable Non-
small-cell Lung Cancer After Sequential Chemoradiotherapy
Submission ID 1311229
Background
Concurrent platinum-based chemoradiotherapy (CRT) followed by maintenance treatment with the
PD-L1 inhibitor durvalumab is the most effective therapy in unresectable stage III non-small-cell
lung cancer (NSCLC). However severe toxicity of this approach may lead to unsatisfactory outcome.
Cardiovascular diseases (CVD) may justify the use of sequential CRT to
avoid severe adverse events and  maintain satisfactory effectiveness.
The main aim of the study was to evaluate all possible prognostic predictors in patients with NSCLC and CVD
treated with sequential CRT.
Method
The study was conducted in the era when maintenance immunotherapy was not available in clinical practice,
but therapeutic role of sequential CRT was assessed. The current available long-term follow-up can define
prognostic determinants.  Overall survival (OS) of 196 patients were analyzed: 101 patients with CVD (51.53%)
and 95 patients with other reasons of qualification for sequential CRT (decreased performance status, older
age, other non-cardiovascular co-morbidities).
Results
There was a statistically nonsignificant trend for lower all-cause mortality in patients with CVD after two
(44.55% vs 53.68%, p=0.2) and three (62.38% vs 69.47%, p=0.3) years of follow-up. By analyzing whether the
quality of cardiological care could have an impact on the prognosis, it was found that patients treated with
beta-blockers had significantly lower all-cause mortality after two (OR=0.45; 95%CI: 0.22-0.89; p=0.02) and
three (OR=0.49; 95%CI:0.25-0.97; p=0.04) years of follow-up. The lowest all-cause mortality was observed
in patients treated with beta-blokers and statins after two (OR=0.22; 95%CI:0.06-0.79; p=0.02), three
(OR=0.21; 95%CI:0.07-0.62; p=0.005) and even four (OR=0.31; 95%CI:0.11-0.89; p=0.03) years of follow-
up. No significant differences were found in the oncological characteristics of NSCLC patients with a better
prognosis due to beta-blockers administration.
Conclusion
Further prospective studies are necessary to confirm the role of beta-blockers (with/without statins) in possible
reduction of mortality in patients undergoing radical chemoradiotherapy in NSCLC.
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