Risk Prediction Models of Cardiotoxicity in Patients With Breast Cancer: Multicenter Prospective CHECK HEART-BC Study (JACC Asia February 2026)-Article: Risk Prediction Models of Cardiotoxicity in Patients With Breast Cancer: Multicenter Prospective CHECK HEART-BC Study

Article: Risk Prediction Models of Cardiotoxicity in Patients With Breast Cancer: Multicenter Prospective CHECK HEART-BC Study

Back to course

Pdf Summary

The multicenter prospective CHECK HEART-BC study aimed to create a practical model to predict chemotherapy-related cardiotoxicity in women with breast cancer. Researchers followed 559 chemotherapy-naïve patients at 25 Japanese institutions for about one year, using echocardiography, biomarkers, and ECGs before and during treatment.<br /><br />Cardiotoxicity was defined as a 10% drop in left ventricular ejection fraction to below 53%. During follow-up, 46 patients (8.2%) developed cardiotoxicity, and most cases were asymptomatic. Patients receiving sequential anthracycline and trastuzumab therapy had higher risk than those receiving other regimens, while no cardiotoxicity occurred with taxane alone.<br /><br />The final prediction tool, called the CHECK HEART score, used six baseline factors: heart rate, left ventricular end-diastolic diameter, left ventricular end-systolic diameter, left ventricular global longitudinal strain, right ventricular fractional area change, and treatment with anthracycline plus trastuzumab. The model showed good predictive performance, with a 12-month time-dependent AUC of 0.82. Risk stratification separated patients into low-, moderate-, and high-risk groups, with cardiotoxicity rates of 2.9%, 15.0%, and 25.6%, respectively.<br /><br />The study also found that both left and right ventricular systolic function worsened gradually over time during chemotherapy, even in patients who did not meet the cardiotoxicity definition. Biomarkers such as BNP and natriuretic peptides were less useful for prediction than imaging and clinical variables.<br /><br />Overall, the CHECK HEART score appears to be a simple and accurate tool for identifying breast cancer patients at higher risk of cardiotoxicity, potentially helping clinicians tailor cardiac surveillance and detect heart damage earlier.

Meta Tag

Concept Cardiovascular Risk Prediction Model

Concept Cardiotoxicity

Concept HEART Score

Concept Left Ventricular Ejection Fraction

Concept Chemotherapy

Keywords

breast cancer

chemotherapy-related cardiotoxicity

CHECK HEART score

anthracycline trastuzumab

echocardiography

left ventricular ejection fraction

cardiac risk prediction

global longitudinal strain

cardiac surveillance

prospective multicenter study

Cardiovascular Risk Prediction Model

Cardiotoxicity

HEART Score

Left Ventricular Ejection Fraction

Chemotherapy