TY - JOUR
T1 - Anthracycline-Induced Cardiomyopathy. Clinical Relevance and Response to Pharmacologic Therapy
AU - Cardinale, Daniela
AU - Colombo, Alessandro
AU - Lamantia, Giuseppina
AU - Colombo, Nicola
AU - Civelli, Maurizio
AU - De Giacomi, Gaia
AU - Rubino, Mara
AU - Veglia, Fabrizio
AU - Fiorentini, Cesare
AU - Cipolla, Carlo M.
PY - 2010/1/19
Y1 - 2010/1/19
N2 - Objectives: The purpose of this study was to evaluate the clinical relevance of anthracycline-induced cardiomyopathy (AC-CMP) and its response to heart failure (HF) therapy. Background: The natural history of AC-CMP, as well as its response to modern HF therapy, remains poorly defined. Hence, evidence-based recommendations for management of this form of cardiomyopathy are still lacking. Methods: We included in the study 201 consecutive patients with a left ventricular ejection fraction (LVEF) ≤45% due to AC-CMP. Enalapril and, when possible, carvedilol were promptly initiated after detection of LVEF impairment. LVEF was measured at enrollment, every month for the first 3 months, every 3 months during the first 2 following years, and every 6 months afterward (mean follow-up 36 ± 27 months). Patients were considered responders, partial responders, or nonresponders according to complete, partial, or no recovery in LVEF, respectively. Major adverse cardiac events during follow-up were also evaluated. Results: Eighty-five patients (42%) were responders; 26 patients (13%) were partial responders, and 90 patients (45%) were nonresponders. The percentage of responders progressively decreased as the time from the end of chemotherapy to the start of HF treatment increased; no complete recovery of LVEF was observed after 6 months. Responders showed a lower rate of cumulative cardiac events than partial and nonresponders (5%, 31%, and 29%, respectively; p <0.001). Conclusions: In cancer patients developing AC-CMP, LVEF recovery and cardiac event reduction may be achieved when cardiac dysfunction is detected early and a modern HF treatment is promptly initiated.
AB - Objectives: The purpose of this study was to evaluate the clinical relevance of anthracycline-induced cardiomyopathy (AC-CMP) and its response to heart failure (HF) therapy. Background: The natural history of AC-CMP, as well as its response to modern HF therapy, remains poorly defined. Hence, evidence-based recommendations for management of this form of cardiomyopathy are still lacking. Methods: We included in the study 201 consecutive patients with a left ventricular ejection fraction (LVEF) ≤45% due to AC-CMP. Enalapril and, when possible, carvedilol were promptly initiated after detection of LVEF impairment. LVEF was measured at enrollment, every month for the first 3 months, every 3 months during the first 2 following years, and every 6 months afterward (mean follow-up 36 ± 27 months). Patients were considered responders, partial responders, or nonresponders according to complete, partial, or no recovery in LVEF, respectively. Major adverse cardiac events during follow-up were also evaluated. Results: Eighty-five patients (42%) were responders; 26 patients (13%) were partial responders, and 90 patients (45%) were nonresponders. The percentage of responders progressively decreased as the time from the end of chemotherapy to the start of HF treatment increased; no complete recovery of LVEF was observed after 6 months. Responders showed a lower rate of cumulative cardiac events than partial and nonresponders (5%, 31%, and 29%, respectively; p <0.001). Conclusions: In cancer patients developing AC-CMP, LVEF recovery and cardiac event reduction may be achieved when cardiac dysfunction is detected early and a modern HF treatment is promptly initiated.
KW - anthracycline-induced cardiomyopathy
KW - carvedilol
KW - chemotherapy
KW - enalapril
KW - heart failure
KW - left ventricular ejection fraction
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U2 - 10.1016/j.jacc.2009.03.095
DO - 10.1016/j.jacc.2009.03.095
M3 - Article
C2 - 20117401
AN - SCOPUS:73549087024
VL - 55
SP - 213
EP - 220
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
SN - 0735-1097
IS - 3
ER -