Multiparametric Integrative Model for Predicting the Risk of Developing Cardiovascular Vasculotoxicity in Antitumor Therapy: Prospects for Personalized Stratification of Cancer Patients

Aim        To develop and validate a simple and clinically convenient multiparametric model combining clinical, instrumental and laboratory predictors to prognose the risk of developing cardiovascular toxicity (CVT) in patients receiving antitumor therapy with subsequent personalized stratification of prevention and treatment.

Material and methods          This multicenter prospective study included 252 patients (mean age 64.8±10.4 years; 64.5% women) with large tumors and lymphoproliferative diseases who received various antitumor treatments. Demographic data, risk factors, echocardiography results, left ventricular ejection fraction, left ventricular global longitudinal strain (GLS), laboratory data (high-sensitivity troponin I/T, terminal pro-brain natriuretic peptide (NT-proBNP), C-reactive protein, lipid profile) were collected. The endpoint of the study was the development of CVT within 12 months according to the criteria of the European Society of Cardiology (2022).

Results    Following multivariate analysis using the Cox model, the most sensitive independent predictors of cardiotoxicity were selected: age >60 years, GLS <-18%, troponin elevation >99th percentile, and NT-proBNP concentration >300 pg/ml. A prognostic model was developed based on the identified parameters. Model validation demonstrated its high validity.

Conclusion            Integration of multicomponent data into a single compact prognostic model ensures high accuracy of assessing the risk for the development of CVT and can become a simple tool for personalized monitoring and prevention in cancer patients.

1. Lyon AR, LópezFernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J et al. 2022 ESC Guidelines on cardiooncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio Oncology Society (ICOS)): Developed by the task force on cardiooncology of the European Society of Cardiology (ESC). European Heart Journal. 2022;43(41):4229–361. DOI: 10.1093/eur-heartj/ehac244

2. Vitsenya M.V., Ageev F.T., Orlova R.V., Poltavskaya M.G., Potievskaya V.I. Cardiovascular toxicity. RUSSCO practical recommendations, part 2. Malignant tumors. 2024;14(3s2):97–121. DOI: 10.18027/2224-5057-2024-14-3s-2206

3. Herrmann J, Lenihan D, Armenian S, Barac A, Blaes A, Cardinale D et al. Defining cardiovascular toxicities of cancer therapies: an International Cardio-Oncology Society (IC-OS) consensus statement. European Heart Journal. 2022;43(4):280–99. DOI: 10.1093/eurheartj/ehab674

4. Haj-Yehia E, Michel L, Mincu RI, Rassaf T, Totzeck M. Prevention of cancer-therapy related cardiac dysfunction. Current Heart Failure Reports. 2025;22(1):9. DOI: 10.1007/s11897-025-00697-x

5. López‐Fernández T, Farmakis D, Ameri P, Asteggiano R, De Azam-buja E, Aznar M et al. European Society of Cardiology Core Curriculum for cardio‐oncology. European Journal of Heart Failure. 2024;26(4):754–71. DOI: 10.1002/ejhf.3102

6. Lyon AR, Dent S, Stanway S, Earl H, Brezden‐Masley C, Cohen‐So lal A et al. Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a position statement and new risk assessment tools from the Cardio-Oncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International Cardio-Oncology Society. European Journal of Heart Failure. 2020;22(11):1945–60. DOI: 10.1002/ejhf.1920

7. Plana JC, Thavendiranathan P, Bucciarelli-Ducci C, Lancellot-ti P. Multi-Modality Imaging in the Assessment of Cardiovascular Toxicity in the Cancer Patient. JACC: Cardiovascular Imaging. 2018;11(8):1173–86. DOI: 10.1016/j.jcmg.2018.06.003

8. Murtuzaliev Sh.M., Salakheeva E.Yu., Kardovskaya S.A., Kirichen-ko Yu.Yu., Siderko E.A., Belenkov Yu.N. et al. Cardiovascular toxicity of car-t cell therapy: a literature review. Clinical Oncohematology. 2024;17(4):404–14. DOI: 10.21320/2500-2139-2024-17-4-404-414

9. Kardanova S.A., Ilgisonis I.S., Ershov V.I., Privalova E.V., Belenkov Yu.N. Characteristic of cardiovascular status and intracardiac hemodynamics in patients with multiple myeloma before the start of antitumor therapy. Kardiologiia. 2022;62(2):4–11. DOI: 10.18087/cardio.2022.2.n1868

10. Daryanani AE, Abbasi MA, Gomez Ardila MF, Tellez-Garcia E, Gar-zon-Dangond JM, Lin Y et al. Baseline echocardiographic variables as predictors of hemodynamically significant cytokine release syndrome in adults treated with CD19 CAR T-cell therapy for hematological malignancies. Cardio-Oncology. 2024;10(1):91. DOI: 10.1186/s40959-024-00290-6

11. Puła B, Kępski J, Misiewicz-Krzemińska I, Szmit S. Left and right ven-tricular global longitudinal strain assessment together with biomarker evaluation may have a predictive and prognostic role in patients qualified for hematopoietic stem cell transplantation due to hematopoietic and lymphoid malignancies – a pilot study description. Cardio-Oncology. 2024;10(1):9. DOI: 10.1186/s40959-024-00210-8

12. Rossello X, Dorresteijn JA, Janssen A, Lambrinou E, Scherrenberg M, Bonnefoy-Cudraz E et al. Risk prediction tools in cardiovascular disease prevention: A report from the ESC Prevention of CVD Programme led by the European Association of Preventive Cardiology (EAPC) in collaboration with the Acute Cardiovascular Care Association (ACCA) and the Association of Cardiovascular Nursing and Allied Professions (ACNAP). European Journal of Cardiovascular Nursing. 2019;18(7):534–44. DOI: 10.1177/1474515119856207

13. Anzai T, Hirata K, Kato K, Kudo K. Correction: Machine learning for cardio-oncology: predicting global longitudinal strain from conventional echocardiographic measurements in cancer patients. CardioOncology. 2025;11(1):57. DOI: 10.1186/s40959-025-00357

14. Tamura Y, et al. Evaluating Troponin-Based Monitoring in Patients Undergoing Immune Checkpoint Inhibitor Therapy. JACC: Advances. 2024;3(12):101374. DOI: 10.1016/j.jacadv.2024.101374

15. Chufal K, Ahmad I, Prakash A, Miller A, Umesh P, Koul V et al. Cardi-ac markers in left-sided breast cancer patients receiving adjuvant radiotherapy: a prospective study. Cardio-Oncology. 2024;10(1):21. DOI: 10.1186/s40959-024-00225-1

16. Samuel NA, Roddick A, Glampson B, Mulla A, Davies J, Papadimi-triou D et al. Prognostic significance of troponin in patients with malignancy (NIHR Health Informatics Collaborative TROP-MALIGNANCY study). Cardio-Oncology. 2024;10(1):41. DOI: 10.1186/ s40959-024-00238-w

17. Leypoldt LB, Guo L, Besemer B, Hänel M, Raab M-S, Mann C et al. Cardiac biomarkers for risk stratification in newly diagnosed high-risk multiple myeloma in the GMMG-CONCEPT trial. Cardio-Oncology. 2025;11(1):63. DOI: 10.1186/s40959-025-00358-x

18. Karput I.A., Snezhitsky V.A., Kurbat M.N., Gorustovich O.A., Kopytsky A.V., Babenko A.S. Molecular genetic indicators of the probability of early myocardial systolic dysfunction signs in doxorubicin chemotherapy in patients with breast cancer of moderate and low HFA-ICOS risk groups. Russian Journal of Cardiology. 2024;29(10):67–79. DOI: 10.15829/1560-4071-2024-5993

19. Akhmedov V.A., Bikbavova G.R., Timofeev V.E., Mikhaleva L.M. Cardiotoxicity of genetic engineered biological therapy in immuno-mediated and oncological diseases. Lechaschi Vrach. 2024;27(3):54–8. DOI: 10.51793/OS.2024.27.3.008