Hubungan Skoring Kardiotoksisitas Ctox terhadap Perubahan Fraksi Ejeksi Ventrikel Kiri pada Pasien Kanker Payudara dengan Kemoterapi dan/atau Terapi Target Trastuzumab

Abstract

Background: Cardiotoxicity is a significant complication of cancer therapy, particularly in breast cancer patients undergoing anthracycline-based chemotherapy and/or trastuzumab-targeted therapy. Cumulative and progressive cardiotoxic effects can lead to left ventricular dysfunction and reduced left ventricular ejection fraction (LVEF). Early detection through risk prediction models such as the Cardiotoxicity Score (CTox) has the potential to help identify patients undergoing cardiotoxic cancer therapy. Objective: To assess the relationship between the CTox cardiotoxicity risk score and changes in LVEF before and after chemotherapy and/or trastuzumab-targeted therapy in breast cancer patients. Methods: This is an observational, analytic study with a retrospective cohort design involving 100 breast cancer patients at H. Adam Malik General Hospital, Medan. Echocardiography was performed before the third cycle and after the fifth cycle of chemotherapy and/or trastuzumab-targeted therapy. Data analysis was performed using a two-way mixed ANOVA. Results: 53% percent of subjects were classified as low-risk and 47% as high-risk for cardiotoxicity based on the Ctox score. Mean LVEF decreased from 62.64 ± 7.80% to 59.95 ± 7.46%, with a mean decrease of 2.69 ± 9.01% (p = 0.004). There was a significant difference in mean LVEF between the low- and high-risk groups (p = 0.001; Partial Eta Squared = 0.115), indicating a medium-large effect size. However, there was no association between high and low-risk cardiotoxicity and LVEF changes before and after chemotherapy and/or trastuzumab-targeted therapy interaction (p = 0.766). Conclusion: LVEF in both high and low risk groups decreased after therapy, although the decrease is not statistically significant between groups. Nevertheless, regular cardiac function monitoring should still be performed in all patients receiving cardiotoxic regimens for early detection of subclinical myocardial impairment and prevention of cardiotoxicity progression.