Association between comorbidity burden and subclinical cardiac dysfunction in cancer patients prior to chemotherapy.

Cross-sectional and retrospective design: associations cannot be interpreted as causal, and only variables consistently documented in medical records could be analysed. Single tertiary centre in Indonesia, limiting generalisability. Heterogeneous population with diverse cancer types and stages, which may have diluted cancer-specific effects. No objective measures of physical fitness (treadmill testing, 6-minute walk, cardiopulmonary exercise testing) were included. Effect sizes were small (correlation coefficients around 0.2) and the multivariable model explained only a small proportion of the variance in E/e', limiting its predictive utility. The authors explicitly state the findings are hypothesis-generating and that prospective studies are needed before any risk-stratified strategy can be recommended.

The authors declare no conflict of interest. The study was internally funded by Universitas Airlangga.

Do not read these modest correlations as a ready-made screening tool for cardiac dysfunction. The multivariable model explained only a small proportion of the variation in filling pressures, the effect sizes were small, and the authors themselves call the findings hypothesis-generating, noting that prospective studies are needed before any risk-stratified monitoring strategy can be recommended.