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Associations Between Sinus Tachycardia and Adverse Cardiovascular Outcomes and Mortality in Cancer Patients
Tochi Okwuosa
Rush University Medical Center
Corresponding Author
ORCiD: https://orcid.org/0000-0001-7666-1217
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Sinus tachycardia in cancer reflects significant multi-system organ stressor and disease, with sparse literature describing its clinical significance. We assessed cardiovascular (CV) and mortality prognostic implications of sinus tachycardia in cancer patients.
Methods
We conducted a case-control study of 622 cancer patients at a U.S. urban medical center from 2008 to 2016. Cases had ECG-confirmed sinus tachycardia (heart rate [HR] ≥ 100 bpm) in ≥ 3 different clinic visits within 1 year of cancer diagnosis excluding history of pulmonary embolism, thyroid dysfunction, left ventricular ejection fraction < 50%, atrial fibrillation/flutter, HR > 180 bpm. Adverse CV outcomes (ACVO) were heart failure with preserved ejection fraction (HFpEF), HF with reduced EF (HFrEF), hospital admissions for HF exacerbation (AHFE), acute coronary syndrome (ACS). Regression analyses were conducted to examine the effect of sinus tachycardia on overall ACVO and survival.
Results
There were 51 cases, age and sex-matched with 571 controls (mean age 70 ± 10, 60.5% women, 76.4% Caucasian). In multivariate analysis over a 10-year follow-up period, sinus tachycardia (HR ≥ 100 vs. < 100 bpm) was an independent predictor of overall ACVO (OR 2.8, 95% CI: 1.4 -5.5; p = 0.006). There was increased incidence of HFrEF (OR 3.3, 95% CI: 1.6- 6.5; P= 0.004) and AHFE (OR 6.3, 95% CI: 1.6-28; P = 0.023), but not HFpEF or ACS (p>0.05) compared with controls. Sinus tachycardia was a significant predictor of overall mortality after adjusting for significant covariates (HR 2.9, 95% CI 1.8-5; p<0.001).
Conclusion
Independent of typical factors that affect cardiovascular disease, sinus tachycardia around the time of cancer treatment is associated with increased ACVO and mortality in cancer patients at 10 years of follow-up.
Keywords
Sinus tachycardia, cancer survivorship, risk prediction, heart failure, outcomes
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On 26 Jan, 2021
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This preprint is under consideration at Cardio-Oncology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Associations Between Sinus Tachycardia and Adverse Cardiovascular Outcomes and Mortality in Cancer Patients
Tochi Okwuosa
Rush University Medical Center
Corresponding Author
ORCiD: https://orcid.org/0000-0001-7666-1217
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Revision
Version 1
Posted 21 Jan, 2021
No community comments so far
Editorial decision: Major Revision
On 21 Feb, 2021
Review #2 received
Received 20 Feb, 2021
Review #1 received
Received 09 Feb, 2021
Reviewer #2 agreed
On 08 Feb, 2021
Reviewer #1 agreed
On 26 Jan, 2021
Reviewers invited
Invitations sent on 25 Jan, 2021
Editor assigned
On 21 Jan, 2021
Editor invited
On 21 Jan, 2021
Submission checks complete
On 19 Jan, 2021
First submitted
On 17 Jan, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Sinus tachycardia in cancer reflects significant multi-system organ stressor and disease, with sparse literature describing its clinical significance. We assessed cardiovascular (CV) and mortality prognostic implications of sinus tachycardia in cancer patients.
Methods
We conducted a case-control study of 622 cancer patients at a U.S. urban medical center from 2008 to 2016. Cases had ECG-confirmed sinus tachycardia (heart rate [HR] ≥ 100 bpm) in ≥ 3 different clinic visits within 1 year of cancer diagnosis excluding history of pulmonary embolism, thyroid dysfunction, left ventricular ejection fraction < 50%, atrial fibrillation/flutter, HR > 180 bpm. Adverse CV outcomes (ACVO) were heart failure with preserved ejection fraction (HFpEF), HF with reduced EF (HFrEF), hospital admissions for HF exacerbation (AHFE), acute coronary syndrome (ACS). Regression analyses were conducted to examine the effect of sinus tachycardia on overall ACVO and survival.
Results
There were 51 cases, age and sex-matched with 571 controls (mean age 70 ± 10, 60.5% women, 76.4% Caucasian). In multivariate analysis over a 10-year follow-up period, sinus tachycardia (HR ≥ 100 vs. < 100 bpm) was an independent predictor of overall ACVO (OR 2.8, 95% CI: 1.4 -5.5; p = 0.006). There was increased incidence of HFrEF (OR 3.3, 95% CI: 1.6- 6.5; P= 0.004) and AHFE (OR 6.3, 95% CI: 1.6-28; P = 0.023), but not HFpEF or ACS (p>0.05) compared with controls. Sinus tachycardia was a significant predictor of overall mortality after adjusting for significant covariates (HR 2.9, 95% CI 1.8-5; p<0.001).
Conclusion
Independent of typical factors that affect cardiovascular disease, sinus tachycardia around the time of cancer treatment is associated with increased ACVO and mortality in cancer patients at 10 years of follow-up.
Figure 1
Figure 2