scholarly journals Age characteristics of risk cardiovascular complications in women with left breast cancer with preserved ejection fraction at the stage of chemotherapy and radiotherapy

Kardiologiia ◽  
2019 ◽  
Vol 59 (7S) ◽  
pp. 23-30
Author(s):  
I. V. Vologdina ◽  
R. M. Zhabina
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
The Elderly ◽  
Cardiovascular Complications ◽  
Left Breast ◽  
Middle Aged ◽  
Aged Patients ◽  
Score Risk

Aim. A study of the risk factors for middle-aged and elderly women HER2neu with negative left breast cancer and a normal ejection fraction at the stage of chemoradiotherapy in everyday clinical practice. Matherial and methods. 61 women with left breast cancer without severe cardiovascular pathology were examined at the stage of doxorubicin therapy and 3D conformal radiation therapy. Group 1 comprised 32 patients of middle age (49.8 ± 4.5 years). Group 2 comprised 29 elderly patients (68.3 ± 3.6 years). In addition to Score risk assessment, additional factors, including psychosocial factors, were studied. All patients underwent ECG, echocardiography and 24-hour ECG monitoring. Anxiety levels were assessed using the HADS scale and scale CH. D. Spielberger –Yu.L. Khanin. The study was conducted before the start of treatment, after the completion of the doxorubicin course and after the completion of the course of radiotherapy. Results with discussion. In middle-aged patients, moderate Score risk was found in 21.9%, in the elderly at 58.6% (p = 0.0043, RR 2.68, 95% CI 1.301–5.520). A high Score risk was found in 15.6% of middle-aged patients and 41.4% of elderly patients (p = 0.0438, RR 2.648, 95% CI 1061–6.607). The most common risk factors in the patients studied in addition to age were heredity, overweight, hypercholesterolemia and diabetes mellitus. All examined patients had moderate reactive anxiety. Patients of middle age have moderate personal anxiety, in elderly patients high personal anxiety. After treatment with doxorubicin in a cumulative dose not exceeding 360 mg/m2 , a reduction in the ejection fraction below 50% was found in 6 middle-aged patients and 17.2% in elderly patients. Asymptomatic diastolic dysfunction was detected in 31.3% of middle-aged patients and 55.2% of the elderly. In patients of both groups, after arranging treatment, arrhythmia was detected. Conclusions. The obtained data indicate to the need for in-depth examination of middle-aged and especially elderly patients with left breast cancer with an assessment of risk factors and conducting an in-depth examination using Echocardiography, 24-hour ECG monitoring and psychological testing to prevent and early detection of cardiovascular complications.

scholarly journals Risk factors for cardiovascular complications in patients with left breast cancer in daily clinical practice

2020 ◽  
Vol 12 (2) ◽  
pp. 63-70
Author(s):  
Elena G. Poroshina ◽  
Irina V. Vologdina ◽  
Razifa M. Zhabina ◽  
Andrey A. Stanzhevsky ◽  
Larisa A. Krasilnikova
Keyword(s):  
Breast Cancer ◽  
Physical Activity ◽  
Risk Factors ◽  
Elderly Patients ◽  
Healthy Lifestyle ◽  
The Elderly ◽  
Cardiovascular Complications ◽  
Left Breast ◽  
Middle Aged ◽  
Aged Patients

Purpose. Detection of adherence to a healthy lifestyle (HLS) and evaluation of behavioral risk factors for cardiovascular complications (CVC), including psychosocial, in patients with left breast cancer at the stage of chemoradiotherapy in daily clinical practice. Materials and methods. The patients were hospitalized for 3D conformal radiation therapy on the bed of the left breast with a total radiation dose (TRD) of 39 Gy (equivalent to 48 Gy of conventional fractionation). All the patients had a Madden mastectomy at the previous stages followed by doxorubicin therapy at a cumulative dose not exceeding 360 mg/m2. Determination of all components of a healthy lifestyle was carried out according to the data of interviewing the participants. The risk category of cardiovascular complications was assessed according to the SCORE scale. Additional characteristics including psychosocial factors were assessed. The examination included ECG and echocardiography. Results. At the initial examination, 58% of middle-aged patients and 74% of elderly patients showed comorbidity, while 18% of middle-aged patients and 29% of elderly patients had multiple comorbidities. Low adherence to healthy lifestyle in the patients was primarily associated with low physical activity due to the existing pain syndrome caused by both the tumor process itself and the surgical intervention. Physical activity in both groups was significantly lower than in the general population. High risk of CVC was significantly more common in the elderly patients. Systolic and diastolic dysfunction as a manifestation of cardiotoxicity after the previous stage of doxorubicin therapy were detected in middle-aged patients in 35.7% of the cases, in the elderly patients in 56.5% of the cases (HR 0.643, 95% CI 0.470-0.880). Psychosocial factors such as acute chronic stress and family problems were the most common. All the examined patients showed moderate reactive anxiety. The elderly patients showed a high level of personal anxiety. Conclusions. The obtained data suggest that in breast cancer patients, low adherence to HLS is primarily associated with low physical activity and unhealthy diet and to a much lesser extent smoking, which is of great importance in the formation of a healthy lifestyle in these patients in the future. In elderly patients, the study significantly more often identified risk factors such as obesity, high blood pressure, hypercholesterolemia and hyperglycemia. These patients revealed increased level of personal anxiety. This highlights the need for an expanded study of not only the main but also additional risk factors.

scholarly journals Evaluation of cardiovascular risk factors in women with left breast cancer of middle-aged and elderly age at the stage of chemotherapy and radiotherapy

2018 ◽  
Vol 10 (2) ◽  
pp. 33-38
Author(s):  
I V Vologdina ◽  
R M Zhabina ◽  
E G Poroshina ◽  
A A Stanzhevsky ◽  
A V Savelieva ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cardiovascular Risk ◽  
Elderly Patients ◽  
Cardiovascular Risk Factors ◽  
Cardiovascular Complications ◽  
Left Breast ◽  
Cardiac Insufficiency ◽  
Middle Aged ◽  
Elderly Age

The study was conducted to identify risk factors for cardiovascular complications in 38 women with HER2neu negative left breast cancer without severe cardiovascular pathology, related both to the clinical features of the patients and the treatmenbeing performed. Patients after radical mastectomy were hospitalized for chemotherapy (doxorubicin in a cumulative dose not exceeding 360 mg/m2) and 3D conformal radiation therapy on the left breast breast of chest radiation doses 39 Gy (equivalent to 48 Gy of normal functioning). Separation into groups was carried out depending on the age: from 20 to 59 years - 20 patients, from 60 to 74 years - 18 patients. It was revealed that the risk of cardiovascular complications in the Score Scale was significantly higher in elderly patients due to age, increased systolic blood pressure and hypercholesterolemia. These patients showed higher rates of BMI and abdominal obesity. The study of psychosocial factors has shown great importance of the transferred stress in the past. The patients of the second group showed high personal anxiety (55.4 ± 3.4, 95% CI 49,6-56,4). In 70% of middle-aged patients and 89% of elderly patients after chemotherapy and radiotherapy cardiotoxicity in the form of cardiac insufficiency of systolic and diastolic dysfunction and asymptomatic cardiac arrhythmias was revealed. (For citation: Vologdina IV, Zhabina RM, Poroshina EG, et al. Evaluation of cardiovascular risk factors in women with left breast cancer of middle-aged and elderly age at the stage of chemotherapy and radiotherapy. Herald of North-Western State Medical University named after I.I. Mechnikov. 2018;10(2):33-38. doi: 10.17816/mechnikov201810233-38).

scholarly journals Prevalence of risk factors of cardiovascular complications in elderly women with left breast cancer

2019 ◽  
Vol 11 (3) ◽  
pp. 85-92
Author(s):  
I. V. Vologdina ◽  
E. G. Poroshina ◽  
R. M. Zhabina ◽  
A. A. Stanzhevsky
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Radiation Therapy ◽  
Elderly Patients ◽  
Elderly Women ◽  
Systolic Dysfunction ◽  
Study Groups ◽  
Cardiovascular Complications ◽  
Left Breast ◽  
Aged Patients

The purpose to study the risk factors for elderly women with left breast cancer at the stage of chemotherapy and radiotherapy in the context of daily clinical practice for early detection of possible cardiovascular complications and optimization of therapy. Material and methods. 69 women with HER2 neu negative left breast cancer without severe cardiovascular disease were examined. The first group included 39 elderly patients (67.7 3.8 years). The second group consisted of 34 middle-aged patients (49.8 5.7 years). In addition to the risk assessment according to the Score scale, additional factors including psychosocial factors were studied. The examination was carried out before the start of treatment, after the end of the course of doxorubicin in a cumulative dose of up to 360 mg/m2 and after the completion of radiation therapy 3D conformal radiation therapy SOD 39 Gr. Results. In elderly patients, risk factors such as obesity, increased cholesterol, and hypertension were significantly more common. In both study groups, low physical activity was revealed associated with both cancer itself and the treatment. All examined patients had moderate reactive anxiety on the Spielberger-Hanin scale. Elderly patients showed high level of personal anxiety; the number of points scored 49.3 3.6. According to the Score scale, a moderate risk was detected in 18 (58.1%) and a high risk in 13(41.9%) elderly patients. After doxorubicin treatment asymptomatic systolic dysfunction was detected in 8 (20.5%) patients (decrease in EF50%), 21 (75%) diastolic dysfunction with relaxation slowdown (E/A1). In 9 (23.1%) of the women without reducing the EF fibrotic changes in the myocardium of the left ventricle was revealed. In 8 (20.5%) women a thickening of the pericardial layer was revealed. Conclusion. The findings suggest the need for a personalized approach and assessment of risk factors in patients of different age groups with left breast cancer at the stage of preparation and conduct of chemoradiotherapy. This highlights the need for enhanced history collection and consideration of not only key but also additional risk factors. The results of the study can be used in the work of practical health care institutions for the planning, development, implementation and control of chemoradiography safety in terms of preventing cardiovascular complications.

scholarly journals HsCRP Variation is the Main Risk Factor for Clinical Outcome in COVID-19 Hospitalized Young and Middle-Aged Patients

2020 ◽  
Author(s):  
Zhelong Liu ◽  
Danning Wu ◽  
Xia Han ◽  
Wangyan Jiang ◽  
Lin Qiu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Elderly Patients ◽  
Clinical Characteristics ◽  
The Elderly ◽  
Middle Aged ◽  
Aged Patients ◽  
Icu Admission ◽  
Discharged Patients ◽  
Independent Risk Factors

Abstract Background: The clinical characteristics and risk factors of clinical outcomes of COVID-19 in elderly and non-elderly patients show great difference. We are the first to explore the relationship between hsCRP variation and intensive care unit (ICU) admission in young and middle-aged COVID-19 patients compared with elderly patients.Methods: We included 273 hospitalized patients with confirmed COVID-19 from Tongji Hospital, Wuhan, China from Feb 10, 2020 to Mar 8, 2020. Clinical characteristics and risk factors of outcomes were compared between young and middle-aged patients with elderly patients.Results: Among young and middle-aged patients, hsCRP variation in those admitted to ICU was significantly higher than that in discharged patients. Among patients admitted to ICU, hsCRP variation showed significantly difference between young and middle-aged patients and elderly patients (median, 67.9 vs -10.2, P < 0.01). The hsCRP variation was an independent risk factor for ICU admission in young and middle-aged patients (OR = 1.068) and ROC curve revealed hsCRP variation significant for the prediction of ICU admission (AUC = 0.925) with 92.9% sensitivity and 95.5% specificity. Conclusion: HsCRP variation is the major independent risk factors for ICU admission in young and middle-aged COVID-19 inpatients, but not in the elderly patients.

scholarly journals Prognosis and risk factors of ERCP pancreatitis in elderly

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Erhan Ergin ◽  
Nevin Oruç ◽  
Galip Ersöz ◽  
Oktay Tekeşin ◽  
Ömer Özütemiz
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Elderly Patients ◽  
Biochemical Analysis ◽  
Female Gender ◽  
The Elderly ◽  
Imaging Findings ◽  
Endoscopic Retrograde ◽  
Sphincter Oddi ◽  
Oddi Dysfunction

AbstractPost Endoscopic Retrograde Cholangiopancreatography (ERCP) pancreatitis is one of the most serious complications of ERCP. Our study aims to investigate the risk, predisposing factors and prognosis of pancreatitis after ERCP in elderly patients. Patients referred to the ERCP unit between April 2008 and 2012 and admitted to the hospital at least 1 day after the ERCP procedure were included to the study. Information including patient’s demographics, diagnosis, imaging findings, biochemical analysis, details of the ERCP procedure and complications were recorded. The severity of post ERCP pancreatitis (PEP) was determined by revised Atlanta Criteria as well as APACHE II and Ranson scores. A total of 2902 ERCP patients were evaluated and 988 were included to the study. Patients were divided into two groups as ≥ 65 years old (494 patients, 259 F, 235 M) and < 65 years old (494 patients, 274 F, 220 M). PEP was diagnosed in 4.3% of patients aged 65 years and older. The female gender was risk factors in elderly for PEP. The Sphincter Oddi Dysfunction (SOD) and Juxta papillary diverticula (JPD) were higher in elderly patients with PEP. Age did not increase the risk of PEP development. The most important post ERCP pancreatitis risk factor in the elderly is the female gender, while the risk is enhanced slightly by SOD and JPD.

Age-associated features of the development of fibrosis and inflamaging in patients with arterial hypertension and ischemic stroke

2022 ◽  
pp. 879-884
Author(s):  
О.А. Осипова ◽  
Е.В. Гостева ◽  
О.Н. Белоусова ◽  
Н.И. Жернакова ◽  
Н.И. Клюшников ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Elderly Patients ◽  
Arterial Hypertension ◽  
Old Age ◽  
Control Group ◽  
Cerebral Stroke ◽  
Middle Aged ◽  
Aged Patients ◽  
Tnf Α ◽  
Immune Inflammation

В статье рассмотрены вопросы развития фиброза и иммунного воспаления у больных артериальной гипертензией (АГ) с острым ишемическим инсультом (ИИ) в пожилом возрасте. Цель исследования - изучение возраст-ассоциированных особенностей концентрации маркеров фиброза (металлопротеиназы-9, тканевого ингибитора матриксных металлопротеиназ-1, их соотношения ММП-9/ТИМП-1), иммунного воспаления (TNF-α, IL-1β, INF-γ) у больных АГ с ИИ. В исследование были включены 86 больных АГ II степени, из которых 42 человека - среднего возраста (53±5 лет) и 44 - пожилого (66±5 лет), контрольную группу составили 22 пациента пожилого возраста с АГ без ИИ в анамнезе. Критерии включения - пациенты с АГ, поступившие в стационар в остром периоде первого церебрального инсульта. Установлено, что у пожилых больных АГ с ИИ показатели инфламэйджинга и маркеры фиброза были достоверно выше, чем у лиц среднего возраста. Уровень IL-1β был выше на 31,7 % (р<0,01), TNF-α - на 55,7 % (р<0,001), INF-γ - на 36,6 % (р<0,01), уровень ММП-9 - на 46,4 % (р<0,01), ТИМП-1 - на 21,2 % (р<0,01), ММП-9/ТИМП-1 - на 19,6 % (р<0,01) в пожилом возрасте по сравнению с больными среднего возраста с АГ и острым ИИ. Таким образом, установлено, что больные АГ с ИИ имеют нарушения процессов инфламейджинга, синтеза и деградации внеклеточного матрикса, особенно выраженные в пожилом возрасте. The article deals with the development of fibrosis and immune inflammation in patients with arterial hypertension and acute ischemic stroke in old age. The aim of the study was to study age-associated features of the concentration of fibrosis markers (metalloproteinase-9, tissue inhibitor of matrix metalloproteinases-1, their ratio MMP-9/TIMP-1), immune inflammation (TNF-α, IL-1β, INF-γ) in patients with arterial hypertension and ischemic stroke (AI). The study included 86 patients with arterial hypertension (AH) of the 2nd degree, of which 42 were middle-aged (53±5 years) and 44 elderly (66±5 years). The control group consisted of 22 elderly patients with AH without a history of AI. The criteria for inclusion in the study are patients with hypertension who were admitted to the hospital in the acute period of the first cerebral stroke. It was found that in elderly patients with hypertension with AI, the indicators of inflamaging and fibrosis markers were significantly higher than in middle-aged people. The level of IL-1β was 31,7 % higher (p<0,01), TNF-α by 55,7 % (p<0,001), INF-γ by 36,6 % (p<0,01), the level of MMP-9 was 46,4 % higher (p<0,01), TIMP-1 by 21,2 % (p<0,01), MMP-9/TIMP-1 by 19,6 % (p<0,01) in the elderly compared to middle-aged patients with hypertension and acute AI. Thus, it was found that patients with arterial hypertension and ischemic stroke have violations of the processes of inflamaging, synthesis and degradation of the extracellular matrix, especially pronounced in old age.

scholarly journals Целевой уровень артериального давления при лечении артериальной гипертензии у пациентов пожилого возраста с хронической сердечной недостаточностью

2019 ◽  
pp. 8-16
Author(s):  
M.S. CHERNIAEVA ◽  
O.D. OSTROUMOVA
Keyword(s):  
Heart Failure ◽  
Blood Pressure ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
Cardiovascular Events ◽  
The Elderly ◽  
Target Blood Pressure ◽  
Lower Systolic Blood Pressure ◽  
Reduced Ejection Fraction ◽  
Increased Risk

Высокая распространенность хронической сердечной недостаточности (ХСН) в популяции пожилых пациентов наряду с устойчивым ро- стом численности пожилого населения как в России, так и в западных странах все больше привлекает внимание врачей к проблеме, связан- ной с ведением данного заболевания. Известно, что ведущим фактором риска развития ХСН является повышенное артериальное давление (АД) и большинство пациентов с ХСН имеют в анамнезе артериальную гипертонию (АГ), поэтому лечение пациентов пожилого возраста c АГ и ХСН является одним из важных направлений в профилактике прогрессирования ХСН, снижения количества госпитализаций и смерт- ности. Лечение АГ у пожилых имеет свои особенности, связанные с функциональным статусом пациентов и их способностью переносить лечение. В европейских рекомендациях (2018) пересмотрены целевые цифры АД при лечении АГ у пожилых, однако данные по целевым цифрам АД для лечения АГ у пациентов с ХСН опираются лишь на исследования, проводившиеся у больных без ХСН. Данные об оптималь- ном целевом уровне у пациентов с АГ и ХСН представлены в единичных исследованиях. В настоящей статье проанализирована взаимосвязь уровня АД и сердечно-сосудистых событий и смертности отдельно для пациентов с АГ и сердечной недостаточностью с низкой фракцией выброса левого желудочка и с сохраненной фракцией выброса левого желудочка. Результаты многих исследований показывают, что более низкий уровень систолического АД (120 мм рт. ст.) и диастолического АД (80 мм рт. ст.) ассоциирован с развитием неблагоприятных сердечно-сосудистых событий, особенно у пациентов с сердечной недостаточностью с низкой фракцией выброса левого желудочка.The high prevalence of chronic heart failure (CHF) in the elderly patients, along with the steady growth of the elderly population, both in Russia and in Western countries, is increasingly attracting the attention of doctors to the problem associated with the management of this disease. It is known that the leading risk factor for CHF is high blood pressure (BP) and most patients with CHF have a history of hypertension (H), so the treatment of elderly patients with H and CHF is the major focus in the slowing CHF progression, reducing the heart failure hospitalisation and mortality. Treatment of hypertension in the elderly has some specific features associated with the functional status of patients and their ability to tolerate treatment. The European recommendations (2018) revised target blood pressure levels in the elderly patients, however, data on target blood pressure levels in patients with CHF are based only on studies conducted in patients without CHF, data on the optimal target blood pressure levels in patients with hypertension and CHF are presented in single studies. In this article we analyze the relationship between blood pressure levels and cardiovascular events and mortality separately for patients with hypertension and heart failure with reduced ejection fraction and with preserved ejection fraction. Several studies show that lower systolic blood pressure (120 mm Hg) and diastolic blood pressure (80 mm Hg) is associated with the increased risk of cardiovascular events, especially in patients with heart failure with reduced ejection fraction.

scholarly journals Feasibility and Safety of Left Bundle Branch Pacing for Advance Aged Patients: A Multicenter Comparative Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Zhongyuan Ren ◽  
Binni Cai ◽  
Songyun Wang ◽  
Peng Jia ◽  
Yang Chen ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Effective Means ◽  
The Elderly ◽  
Elderly Group ◽  
Complication Rates ◽  
Related Complication ◽  
Aged Patients ◽  
Fluoroscopic Time ◽  
Symptomatic Bradycardia

Background: Left bundle branch pacing (LBBP) has been shown to be a safe and effective means to achieve physiological pacing. However, elderly patients have increased risks from invasive procedures and the risk of LBBP in elderly patients is not known. We aimed to investigate the safety and efficacy of LBBP in elderly patients &gt;80 years of age.Methods: From December 2017 to June 2019, 346 consecutive patients with symptomatic bradycardia, 184 patients under 80 years of age and 162 over 80 years, were included and underwent LBBP. The safety and prognosis of LBBP were comparatively evaluated by measured pacing parameters, periprocedural complications, and follow-up clinical events.Results: Compared with the younger, the elderly group had worse baseline cardiac and renal function. LBBP was achieved successfully in both groups with comparable fluoroscopic time and paced QRS duration (110.0 [102.0, 118.0] ms for the young vs. 110.0 [100.0, 120.0] ms for the elderly, P = 0.874). Through a follow-up of 20.0 ± 6.1 months, pacing parameters were stable while higher threshold and impedance were observed in the elderly group. In the evaluation of safety, overall procedure-related complication rates were comparable (4.4 vs. 3.8%, young vs. elderly). For prognosis, similar rates of major adverse cardiocerebrovascular events (7.1 vs. 11.9%, young vs. elderly) were observed.Conclusions: Compared to younger patients, LBBP could achieve physiological pacing in patients over 80 with comparable midterm safety and prognosis. Long-term safety and benefits of LBBP, however, necessitate further evaluation.

Abstract 12732: Risk of Heart Failure After Contemporary Radiotherapy for Breast Cancer in the Community

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Hirofumi Saiki ◽  
Randi R Finley ◽  
Christopher G Scott ◽  
Elizabeth S Yan ◽  
Ivy A Petersen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Heart Failure ◽  
Ejection Fraction ◽  
Conditional Logistic Regression ◽  
Continuous Variable ◽  
Endothelial Damage ◽  
Myocardial Inflammation ◽  
Reduced Ejection Fraction ◽  
Breast Cancer Radiotherapy

Background: Contemporary breast cancer radiotherapy (RT) results in variable cardiac radiation exposure. While cardiomyocytes are radio-resistant, radiation induces coronary microvascular endothelial damage and inflammation which may ultimately lead to myocardial inflammation, ischemia and fibrosis and put patients at risk for heart failure (HF) and particularly, HF with preserved ejection fraction (HFpEF). Methods: Community based (Olmsted County, MN), HF case-control study of contemporary (1999-2014) breast cancer RT patients with CT-based RT planning for precise mean cardiac radiation dose (MCRD) calculation. HF cases (n=66) and controls (n=129) were matched (1:2) for age at RT, HF risk factors, tumor side and chemotherapy use. Matched controls and cases had identical follow-up (index interval). Proportion of HF and clinical characteristics in categories of MCRD were reported (table) and conditional logistic regression was used to estimate the HF odds ratio (OR) associated with MCRD as a continuous variable. Results: Of the 66 HF cases, 46 (70%) had HFpEF and 20 (30%) had HF with reduced ejection fraction (HFrEF). The proportion of patients with HF (any) or HFpEF increased and proportion with HFrEF tended to increase with increasing MCRD. The prevalence of HF risk factors (hypertension, diabetes, coronary disease) at time of RT did not vary by MCRD while left sided tumor, cancer stage and adriamycin use increased with increasing MCRD. The OR per 1 unit increase in log MCRD was 3.71 (1.98, 6.94) for total HF (p<0.001), 4.91 (1.93, 9.09) for HFpEF (p<0.001) and 2.78 (0.91, 8.47) for HFrEF (p=0.07). The mean index interval was 5.0±3.2 years. Conclusion: Cardiac radiation incident to contemporary breast RT increases the risk of HF, and particularly HFpEF over a short post-RT interval. These data may guide use of proton beam therapy in breast cancer. These data also provide support for the role of coronary microvascular compromise in the pathophysiology of HFpEF.

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