Role of afterload reduction in the prevention of late anthracycline cardiomyopathy.
Afterload reduction is useful for treating and preventing adult congestive heart failure outside the realm of anthracycline toxicity. Afterload reducers are commonly used as treatment for acute heart failure associated with anthracyclines. However, the use of afterload reduction for the prevention of anthracycline associated late cardiomyopathy remains a controversial area, with strong opinions expressed concerning the potential risks and benefits of such an approach. This article will define "afterload" and the tools utilized to measure afterload. The study will then describe the theory for the use of afterload reduction in patients with anthracycline exposure who show signs of anthracycline cardiotoxicity, and will present data from the ACE-Inhibitor After Anthracyclines (AAA) Trial to help answer the question, "Should an afterload reducer be used to aid in preventing late anthracycline cardiotoxicity?" Finally, recommendations for future research will be presented.
Silber
Jeffrey H
JH
Division of Pediatric Oncology, Department of Pediatrics, Center for Outcomes Research, The Children's Hospital of Philadelphia and The University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania 19104, USA. Silber@email.chop.edu
D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D018943:Anthracyclines / Q000009:adverse effects*; D009202:Cardiomyopathies / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control*; D005544:Forecasting; D017408:Guidelines as Topic; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy*
D000806:Angiotensin-Converting Enzyme Inhibitors; D018943:Anthracyclines