Anthracycline-induced cardiomyopathy: clinical relevance and response to pharmacologic therapy.
OBJECTIVE
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) <or=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.
Cardinale
Daniela
D
Cardiology Unit, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy. daniela.cardinale@ieo.it
Colombo
Alessandro
A
Lamantia
Giuseppina
G
Colombo
Nicola
N
Civelli
Maurizio
M
De Giacomi
Gaia
G
Rubino
Mara
M
Veglia
Fabrizio
F
Fiorentini
Cesare
C
Cipolla
Carlo M
CM
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D018943:Anthracyclines / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002227:Carbazoles / Q000627:therapeutic use; D000077261:Carvedilol; D015331:Cohort Studies; D004656:Enalapril / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000139:chemically induced* / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000503:physiopathology; D011412:Propanolamines / Q000627:therapeutic use; D020127:Recovery of Function; D013318:Stroke Volume; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D018943:Anthracyclines; D000970:Antineoplastic Agents; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D004656:Enalapril