Time-Varying Spatial Ventricular Gradient Orientation Is Associated With Anthracycline Heart Failure
5 affiliations
- 1Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- 2Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
- 3Richard A. And Susan F. Smith Institute for Evidence, Innovation, and Policy, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- 4National Heart and Lung Institute, Imperial College London, United Kingdom
- 5Department of Cardiology, Imperial College Healthcare NHS Trust, London, United Kingdom
Abstract
Background: Anthracycline use is limited by cardiotoxicity resulting in heart failure (HF). The spatial ventricular gradient (SVG) is a vectorcardiographic measurement of myocardial electrical heterogeneity associated with sudden death and incident HF. It is unclear if serial measurement of SVG after anthracycline initiation can help predict subsequent HF.
Objectives: The objective of the study was to determine if time-varying SVG measurements are associated with anthracycline HF.
Methods: Retrospective, single-center study of adult patients with cancer treated with anthracyclines between 1992 to 2019. Standard 12-lead electrocardiograms obtained within 6 months before and up to 5 years after anthracycline initiation were analyzed. Patients with prior HF or ≤1 electrocardiogram within 5 years were excluded. Median vectorcardiograms were constructed, and the SVG vector was obtained by integrating under the X, Y, and Z QRST complexes. Multivariable competing-risks regression was performed with SVG parameters included as time-varying covariates, incident HF as the main outcome, and death as a competing outcome.
Results: Among 594 patients (median age 61 years, 48% male), 83 (14%) developed HF within 5 years. In multivariable competing-risks regression, time-varying SVG azimuth (circular angle in the transverse plane) was independently associated with HF (P = 0.0024), demonstrating a 9.4-fold gradient in risk across values. Leftward/anterior azimuth values were the lowest risk areas, whereas posterior/rightward orientations were the highest risk.
Conclusions: Time-varying SVG azimuth was independently associated with HF risk in patients treated with anthracyclines. Assessing dynamic changes in SVG azimuth during anthracycline treatment may enhance early identification of patients at risk for HF and inform the use of cardioprotective strategies during cancer therapy.
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BibTeX
@article{diaz2026timevarying,
title = {{Time-Varying Spatial Ventricular Gradient Orientation Is Associated With Anthracycline Heart Failure}},
author = {Andrea Nathalie Rosas Diaz and Hans Friedrich Stabenau and Patricia Tung and Jason Nelson and Gabriel Pajares Hurtado and Sarah Warack and Sanam Alilou and Arunashis Sau and Nicholas S. Peters and Fu Siong Ng and Jenica N. Upshaw and Daniel B. Kramer and Aarti Asnani and Jonathan W. Waks},
journal = {JACC: Advances},
year = {2026},
month = oct,
doi = {10.1016/j.jacadv.2026.103353},
url = {https://doi.org/10.1016/j.jacadv.2026.103353},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Time-Varying Spatial Ventricular Gradient Orientation Is Associated With Anthracycline Heart Failure
AU - Andrea Nathalie Rosas Diaz
AU - Hans Friedrich Stabenau
AU - Patricia Tung
AU - Jason Nelson
AU - Gabriel Pajares Hurtado
AU - Sarah Warack
AU - Sanam Alilou
AU - Arunashis Sau
AU - Nicholas S. Peters
AU - Fu Siong Ng
AU - Jenica N. Upshaw
AU - Daniel B. Kramer
AU - Aarti Asnani
AU - Jonathan W. Waks
PY - 2026
DA - 2026/10/20
JO - JACC: Advances
DO - 10.1016/j.jacadv.2026.103353
UR - https://doi.org/10.1016/j.jacadv.2026.103353
AB - Background: Anthracycline use is limited by cardiotoxicity resulting in heart failure (HF). The spatial ventricular gradient (SVG) is a vectorcardiographic measurement of myocardial electrical heterogeneity associated with sudden death and incident HF. It is unclear if serial measurement of SVG after anthracycline initiation can help predict subsequent HF. Objectives: The objective of the study was to determine if time-varying SVG measurements are associated with anthracycline HF. Methods: Retrospective, single-center study of adult patients with cancer treated with anthracyclines between 1992 to 2019. Standard 12-lead electrocardiograms obtained within 6 months before and up to 5 years after anthracycline initiation were analyzed. Patients with prior HF or ≤1 electrocardiogram within 5 years were excluded. Median vectorcardiograms were constructed, and the SVG vector was obtained by integrating under the X, Y, and Z QRST complexes. Multivariable competing-risks regression was performed with SVG parameters included as time-varying covariates, incident HF as the main outcome, and death as a competing outcome. Results: Among 594 patients (median age 61 years, 48% male), 83 (14%) developed HF within 5 years. In multivariable competing-risks regression, time-varying SVG azimuth (circular angle in the transverse plane) was independently associated with HF (P = 0.0024), demonstrating a 9.4-fold gradient in risk across values. Leftward/anterior azimuth values were the lowest risk areas, whereas posterior/rightward orientations were the highest risk. Conclusions: Time-varying SVG azimuth was independently associated with HF risk in patients treated with anthracyclines. Assessing dynamic changes in SVG azimuth during anthracycline treatment may enhance early identification of patients at risk for HF and inform the use of cardioprotective strategies during cancer therapy.
SN - 2772-963X
ER -