Cancer Therapy–Related Cardiac Dysfunction in Patients With Prostate Cancer Undergoing Androgen Deprivation Therapy

Dong Yi Chen, Cheng Hung Lee, Ming Lung Tsai, Ming Jer Hsieh, Cheng Keng Chuang, See Tong Pang, Shao Wei Chen, Chi Nan Tseng, Shang Hung Chang, Pao Hsien Chu, I. Chang Hsieh, Victor Chien Chia Wu*, Wen Kuan Huang*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

Abstract

BACKGROUND: The risk of cardiac dysfunction for patients with prostate cancer undergoing androgen deprivation therapy (ADT) in the real-world setting remains unclear. METHODS AND RESULTS: A total of 1120 patients with prostate cancer and a baseline echocardiography scan were identified from Chang Gung Research Database between January 1, 2001 and December 31, 2019. Patients were treated with gonadotropin-releasing hormone agonist therapy, gonadotropin-releasing hormone antagonist therapy, or bilateral orchiec-tomy. Changes in left ventricular ejection fraction (LVEF) were further assessed in 421 patients using repeated measurements of LVEF before and during ADT treatment. The incidence of cancer therapy– related cardiac dysfunction (CT-RCD) was evalu-ated and defined as a ≥10% absolute decline in LVEF from baseline to a value of <53%. Among 421 patients undergoing ADT, LVEF declined from 66.3±11.3% to 62.5±13.6% (95% CI of mean difference: −5.0% to −2.7%) after a mean follow-up period of 1.6±0.8 years. CT-RCD occurred in 58 patients (13.7%) with a nadir LVEF of 40.3±9.1% after ADT. Lower baseline LVEF was significantly associated with CT-RCD (odds ratio, 1.07 [95% CI, 1.04–1.10]). The area under the curve of baseline LVEF for dis-criminating CT-RCD was 75.6%, with the corresponding optimal cutoff value of 64.5% (sensitivity, 79.3%; specificity, 67.2%). CONCLUSIONS: ADT with gonadotropin-releasing hormone agonist therapy, gonadotropin-releasing hormone antagonist ther-apy, and bilateral orchiectomy were associated with an increased risk of CT-RCD in patients with prostate cancer. In addition, lower baseline LVEF was a significant predictor of CT-RCD in patients with prostate cancer undergoing treatment with ADT.

Original languageEnglish
Article numbere030447
Pages (from-to)e030447
JournalJournal of the American Heart Association
Volume12
Issue number19
DOIs
StatePublished - 03 10 2023

Bibliographical note

Publisher Copyright:
© 2023 The Authors.

Keywords

  • androgen deprivation therapy
  • cardiovascular toxicity
  • prostate cancer
  • Androgen Antagonists/adverse effects
  • Ventricular Function, Left
  • Humans
  • Orchiectomy/adverse effects
  • Male
  • Stroke Volume
  • Heart Diseases/chemically induced
  • Androgens
  • Prostatic Neoplasms/drug therapy
  • Gonadotropin-Releasing Hormone

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