A Simple Clinical Risk Score to Improve Prediction of Anthracycline-Induced Cardiotoxicity (JACC: CardioOncology State-of-the-Art Review August 2026)-Article: A Simple Clinical Risk Score to Improve Prediction of Anthracycline-Induced Cardiotoxicity

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This study evaluated whether anthracycline-related cardiotoxicity can be predicted more simply and accurately in cancer patients. The authors analyzed 2,612 adults treated with anthracyclines in a derivation cohort and validated the findings in an independent cohort of 819 patients. Cardiotoxicity was defined as a drop in left ventricular ejection fraction (LVEF) of at least 10 percentage points to below 50%, or the development of heart failure.<br /><br />The current guideline-based HFA-ICOS score was confirmed to stratify baseline risk well, with higher risk categories showing higher cardiotoxicity rates. However, because this tool uses many variables, it may be cumbersome in routine practice. The study therefore developed a much simpler post-treatment model, called the RE-ACT score, using only two predictors: LVEF measured shortly after chemotherapy and cumulative anthracycline dose.<br /><br />The RE-ACT score performed well. In the derivation cohort, its 1-year AUC was 0.83, and in the external validation cohort it achieved an AUC of 0.88, indicating strong discrimination. Machine-learning analyses confirmed the same two predictors as the most informative. When the RE-ACT score was combined with the HFA-ICOS score, predictive performance improved further, suggesting the two tools provide complementary information: HFA-ICOS captures baseline vulnerability, while RE-ACT captures treatment-related myocardial injury.<br /><br />Overall, cardiotoxicity occurred mainly within the first year after therapy, with little added event burden afterward. The authors conclude that a practical two-step strategy may be best: use HFA-ICOS before treatment to assess baseline risk, then apply RE-ACT after chemotherapy to refine surveillance and guide cardioprotective follow-up.

Meta Tag

Concept Anthracycline-Induced Cardiomyopathy

Concept Risk Stratification

Concept HFA-ICOS Score

Concept RE-ACT Score

Concept Left Ventricular Ejection Fraction

Keywords

anthracycline cardiotoxicity

left ventricular ejection fraction

heart failure

HFA-ICOS score

RE-ACT score

cancer patients

cumulative anthracycline dose

risk prediction

cardio-oncology

external validation

Anthracycline-Induced Cardiomyopathy

Risk Stratification

HFA-ICOS Score

RE-ACT Score

Left Ventricular Ejection Fraction