[Angiotensin-converting enzyme inhibitor in the treatment of epirubicin-induced dilated cardiomyopathy].
Anthracycline chemotherapy of cancer can cause severe, frequently fatal congestive heart failure (CHF), the first line treatment for which is diuretics and digoxin. We have studied the use of an ACE-inhibitor added as a third agent. Of 85 patients evaluable for cardiotoxicity after treatment with a median of 1000 mg/m2 of epirubicin for metastatic breast cancer, nine developed CHF at 1.5 to 13 months after therapy. Left ventricular ejection fraction decreased from normal to 18 to 35%. All patients received digitalo-diuretic therapy and after a transient clinical relief enalapril or ramipril increasing from 1.25 mg orally daily to 10-15 mg after 4-6 weeks. Eight of the nine patients deteriorated while on digitalo-diuretic therapy. Within three months of starting the ACE-inhibitor in these patients, LVEF increased to normal or near normal. Only one patient died in heart failure. Follow-up ranged from 11-42 months (median 26) and survival in the nine patients was similar to that of those who did not develop CHF. We suggest that treatment of anthracycline-induced CHF with an ACE-inhibitor should start within one to two weeks after digitalo-diuretic therapy regardless of the severity of symptoms rather than waiting for clinical deterioration.
Jensen
B V
BV
Klinisk fysiologisk nuklearmedicinsk afdeling, Amtssygehuset i Herlev.
Nielsen
S L
SL
Jensen
T S
TS
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage*; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000556:secondary; D002311:Cardiomyopathy, Dilated / Q000139:chemically induced / Q000188:drug therapy* / Q000473:pathology; D004656:Enalapril / Q000008:administration & dosage; D015251:Epirubicin / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008875:Middle Aged
D000806:Angiotensin-Converting Enzyme Inhibitors; D000903:Antibiotics, Antineoplastic; D000970:Antineoplastic Agents; D015251:Epirubicin; D004656:Enalapril