TOPLINE:
Cardiac dysfunction associated with vascular endothelial growth factor (VEGF) inhibitors in cancer therapy was common and tended to occur early. Increases in home-measured blood pressure (BP) and N-terminal pro–brain natriuretic peptide (NT-proBNP) levels, along with a decrease in the left ventricular ejection fraction (LVEF), were observed within 4 weeks of treatment initiation.
METHODOLOGY:
- VEGF inhibitors provide significant benefits for cancer through the inhibition of angiogenesis; however, their use is linked to cardiovascular toxicities.
- Researchers conducted a prospective observational study from 2019 to 2021 involving 78 patients with cancer, initiating VEGF inhibitor treatment (mean age, 62.7 years; 68% men) to investigate the incidence, time course, and mechanisms of associated cardiac dysfunction and hypertension.
- Participants underwent BP monitoring, ECG, LVEF assessment, and measurement of cardiac biomarkers (high-sensitivity troponin T and NT-proBNP) at baseline and over the 24-week treatment period. A substudy was performed using serial adenosine stress perfusion cardiovascular MRI.
- Asymptomatic moderate cancer therapy–related cardiac dysfunction was defined as an LVEF reduction of ≥ 10% from baseline to a value between 40% and < 50%, or an LVEF reduction of < 10% to the same range, accompanied by > 15% reduction in global longitudinal strain or an increase in cardiac biomarker levels.
- VEGF inhibitor–induced hypertension was defined as a rolling 7-day average of home-measured BP ≥ 135/ ≥ 85 mm Hg, according to measurements taken on at least 3 days within a 7-day period and the initiation or escalation of antihypertensive therapy or a ≥ 20 mm Hg increase in systolic or diastolic BP in patients with baseline levels above this threshold.
TAKEAWAY:
- Overall, 19% of patients developed at least moderate VEGF inhibitor–related cardiac dysfunction with symptoms evident in 93% of cases at 4 weeks of treatment initiation.
- At 4 weeks, the overall LVEF decreased by 4.2% (P < .001). Among patients who developed moderate cardiac dysfunction, LVEF decreased by 11.3% during the same period (P < .001).
- Furthermore, 79% of patients developed VEGF inhibitor–induced hypertension; home-measured systolic and diastolic BP values increased by 7.2 mm Hg and 4.8 mm Hg, respectively, at 1 week (both P < .001), with these elevations persisting through 4 weeks.
- At 4 weeks, NT-proBNP levels were elevated (P < .001) in patients who developed cardiac dysfunction, whereas no changes were noted in those who did not develop cardiac dysfunction. Cardiac MRI showed significant reductions in LVEF, native T1 relaxation times, and resting myocardial blood flow at 4 weeks.
IN PRACTICE:
“Given the frequency, timing and potential reversibility of VEGFI [VEGF inhibitor]-associated CTRCD [cancer therapy–related cardiac dysfunction], these findings suggest that after pre-VEGFI assessments, priority should be given to early assessment of left ventricular function (4 weeks) after starting VEGFI. This strategy could allow for optimal detection of VEGFI-associated CTRCD and, importantly, may offer the opportunity to make meaningful interventions to improve LV function before potentially irreversible effects,” the authors wrote.
SOURCE:
This study was led by Stephen J.H. Dobbin of the University of Glasgow BHF Glasgow Cardiovascular Research Centre, Glasgow, Scotland. It was published online on April 3, 2025, in Heart.
LIMITATIONS:
The generalizability of the findings was limited since not all patients underwent both the imaging modalities. The broad eligibility criteria might have introduced baseline heterogeneity and limited subgroup assessment. The study population included patients with potentially advanced malignancies, which led to some missing data and follow-up.
DISCLOSURES:
This study was funded by a grant from the British Heart Foundation. Four authors were supported by a BHF Centre of Research Excellence Award. One author reported being employed by the University of Glasgow, which holds consultancy and research agreements for his work with several pharmaceutical and healthcare companies. Several other authors reported having financial ties with various companies.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.