A Simple Clinical Risk Score to Improve Prediction of Anthracycline-Induced Cardiotoxicity

BACKGROUND: Anthracycline-induced cardiotoxicity is a major limitation of cancer therapy, highlighting the need for accurate and practical risk stratification. Although current guidelines recommend the Heart Failure Association-International Cardio-Oncology Society (HFA-ICOS) score for baseline risk assessment, its complexity may limit routine clinical use. OBJECTIVES: This study sought to develop and validate a simplified risk score based on readily available clinical and echocardiographic variables for predicting anthracycline-related cardiotoxicity, and to compare its performance with the HFA-ICOS model. METHODS: We retrospectively analyzed 2,612 adult cancer patients with baseline left ventricular ejection fraction (LVEF) of ≥50% treated with anthracyclines. Echocardiography was performed at baseline, during therapy, and up to 2 years after treatment. Cardiotoxicity was defined as a decrease in LVEF of >10 percentage points to a value