Research from the National Center for Cardiovascular Research (CNIC) questions the utility of systematic intensive cardiologic surveillance programs for lymphoma patients with low or moderate cardiovascular risk treated with anthracyclines. The findings of the MATRIX study, published in JACC: CardioOncology, indicate that monitoring via cardiac magnetic resonance, advanced echocardiography, and biomarkers only detects mild subclinical alterations, without translating into relevant cardiovascular events during follow-up months after treatment.
The MATRIX project, funded by the European Commission through an ERC Consolidator grant, aims to develop novel, cutting-edge treatments for cardiac toxicity associated with certain cancer therapies. Anthracyclines are highly effective for numerous hematologic cancers but can cause cardiac toxicity, leading clinical guidelines to recommend cardiovascular surveillance during and after treatment. However, most of these recommendations are based on expert consensus, with limited data on their real-world utility in patients at low or intermediate cardiovascular risk.
“The objective of this study was to answer a highly relevant question for clinical practice: whether intensive cardiologic surveillance provides clinically useful information in patients at low risk of developing cardiotoxicity,” explains Dr. Andrea Moreno-Arciniegas, lead author of the work and CNIC researcher.
MATRIX included 44 patients with a recent diagnosis of lymphoma who were scheduled to receive anthracycline-based chemotherapy. All underwent a comprehensive cardiovascular evaluation using cardiac magnetic resonance, echocardiography, and cardiac biomarker determination before, during, and after treatment. Researchers observed that nearly half of the patients met criteria for treatment-related cardiac dysfunction according to current European guidelines, but this proportion decreased notably when certain blood biomarkers were not considered. Most detected alterations were mild, transient, and non-progressive.
“What we observed is that many of the abnormalities identified by intensive surveillance programs were not associated with an unfavorable clinical evolution during follow-up,” notes Dr. Sandra Gómez-Talavera, a CNIC researcher and co-author of the study.
The authors also found that a significant portion of biomarker elevations were already present before chemotherapy initiation and tended to normalize over time, suggesting they might reflect processes related to the oncological disease or systemic stress rather than progressive cardiac damage. The results support the need to adapt the intensity of cardiologic follow-up to each patient's individual risk.
“These findings suggest that a personalized, risk-based approach could be more efficient than applying intensive surveillance protocols uniformly to all patients,” explains Dr. Borja Ibáñez, the study leader. Early identification of cardiotoxicity remains a clinical priority, but it is necessary to optimize the balance between early detection, clinical benefit, and healthcare resource utilization.
“We need larger studies with longer follow-ups to determine which subclinical findings truly have prognostic relevance and which patients benefit most from intensive surveillance,” adds Dr. Teresa López-Fernández, a cardiologist at Hospital Universitario La Paz in Madrid and co-author of the study. The authors acknowledge that results should be interpreted with caution due to the relatively small cohort size and follow-up duration, but they believe the findings provide relevant information for future updates to cardiovascular surveillance strategies in cancer patients.
