title: Increased need for right ventricular support in patients with chemotherapy-induced cardiomyopathy undergoing mechanical circulatory support: outcomes from the INTERMACS Registry (Interagency Registry for Mechanically Assisted Circulatory Support).
abstract: OBJECTIVE
  The aim of this study was to investigate the use of durable mechanical circulatory support (MCS) in patients with chemotherapy-induced cardiomyopathy (CCMP) and determine their outcomes and survival in comparison to that of other patients with end-stage heart failure treated similarly.
  
  
  BACKGROUND
  Patients with end-stage heart failure as a result of CCMP from anthracyclines are often precluded from heart transplantation because of a history of cancer. In such patients, durable MCS may offer an important chance for life prolongation. Yet, there are no data to support the use of MCS in this increasingly prevalent group of patients.
  
  
  METHODS
  We searched 3,812 MCS patients from June 2006 through March 2011 in the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) database for the diagnosis of CCMP. We compared characteristics, outcomes, and survival between CCMP patients and patients with nonischemic cardiomyopathy and ischemic cardiomyopathy.
  
  
  RESULTS
  Compared with patients with nonischemic cardiomyopathy and ischemic cardiomyopathy, patients with CCMP were overwhelmingly female (72% vs. 24% vs. 13%, p = 0.001), had MCS more often implanted as destination therapy (33% vs. 14% vs. 22%, p = 0.03), required more right ventricular assist device support (19% vs. 11% vs. 6%, p = 0.006), and had a higher risk of bleeding (p = 0001). Survival of CCMP patients was similar to that of other groups.
  
  
  CONCLUSIONS
  CCMP patients treated with MCS have survival similar to other MCS patients despite more frequent need for right ventricular assist device support and increased bleeding risk.
authors.affiliation: Advanced Heart Failure and Transplantation Center, Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio. Electronic address: guilherme.oliveira@UHhospitals.org.
authors.forename: Guilherme H
authors.initials: GH
authors.lastname: Oliveira
authors.affiliation: Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: Matthias
authors.initials: M
authors.lastname: Dupont
authors.affiliation: Cardiovascular Surgery Research, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: David
authors.initials: D
authors.lastname: Naftel
authors.affiliation: Cardiovascular Surgery Research, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Myers
authors.affiliation: Cardiovascular Surgery Research, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Ya
authors.initials: Y
authors.lastname: Yuan
authors.affiliation: Advanced Heart Failure and Transplantation Center, Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: W H Wilson
authors.initials: WH
authors.lastname: Tang
authors.affiliation: Department of Cardiothoracic Surgery, Baylor Medical Center, Dallas, Texas.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Gonzalez-Stawinski
authors.affiliation: Advanced Heart Failure and Transplantation Center, Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: James B
authors.initials: JB
authors.lastname: Young
authors.affiliation: Advanced Heart Failure and Transplantation Center, Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: David O
authors.initials: DO
authors.lastname: Taylor
authors.affiliation: Advanced Heart Failure and Transplantation Center, Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
authors.forename: Randall C
authors.initials: RC
authors.lastname: Starling
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D009202:Cardiomyopathies / Q000139:chemically induced / Q000401:mortality / Q000628:therapy*; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006353:Heart-Assist Devices / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents
keywords: CCMP; ICMP; LVAD; MCS; NICMP; RV; RVAD; assist devices; chemotherapy-induced cardiomyopathy; heart failure; ischemic cardiomyopathy; left ventricular assist device; mechanical circulatory support; nonischemic cardiomyopathy; right ventricular; right ventricular assist device