title: Cardiac dysfunction among soft tissue sarcoma patients in Denmark.
abstract: OBJECTIVE
  Soft tissue sarcoma (STS) patients may experience post-treatment cardiotoxicity, yet no population-based data exist. We examined the incidence of left ventricular ejection fraction (LVEF) decline, heart failure, and cardiac death following STS diagnosis among adults, using Danish patient registries and medical record review.
  
  
  METHODS
  LVEF decline was examined in a regional cohort of STS patients diagnosed during 1997-2011 in Western Denmark for whom cardiac imaging data were available. LVEF decline was defined as an absolute decline from baseline to follow-up of 10% or more, or, where baseline imaging was not available, a decline below the lower limit of normal (or 40%) for a follow-up LVEF. Heart failure and cardiac death were investigated in a national Danish cohort of all STS patients diagnosed from 2000 to 2009. We followed patients from STS diagnosis until heart failure, cardiac death, emigration or December 31, 2012 (whichever occurred first).
  
  
  RESULTS
  The incidence rate of LVEF decline for the regional cohort with follow-up data (N=100, five events) or baseline and follow-up measurements (N=75, 19 events) was 16.8 (95% confidence interval [CI]: 7.0-40.3) and 108 (95% CI: 69-170), respectively, per 1,000 person-years. In the national cohort (N=1,187), the incidence of heart failure (40 events) and cardiac death (15 events) was 7.3 (95% CI: 5.4-10.0) and 2.7 (95% CI: 1.6-4.5), respectively, per 1,000 person-years. The strongest predictors of heart failure were doxorubicin treatment (hazard ratio [HR] =2.2, 95% CI: 0.5-10.2) and pre-existing cardiovascular disease (HR=6.3, 95% CI: 0.98-40.6).
  
  
  CONCLUSIONS
  LVEF decline occurred more frequently compared to heart failure or cardiac death in a nationally representative cohort of Danish STS patients.
authors.affiliation: Worldwide Epidemiology Department, GlaxoSmithKline Pte Ltd, Singapore.
authors.forename: Sumitra
authors.initials: S
authors.lastname: Shantakumar
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: Olsen
authors.affiliation: Worldwide Epidemiology, GlaxoSmithkline, Research Triangle Park, USA.
authors.forename: Thao T
authors.initials: TT
authors.lastname: Vo
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Nørgaard
authors.affiliation: Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Pedersen
keywords: LVEF; cardiac death; heart failure; sarcoma