title: A Matched Cohort Study of Patients With End-Stage Heart Failure from Anthracycline-Induced Cardiomyopathy Requiring Advanced Cardiac Support.
abstract: Anthracycline-induced cardiomyopathy (AIC) may progress to end-stage heart failure requiring mechanical circulatory support or orthotopic heart transplantation (OHT). Previous studies have described important clinical differences between AIC and nonischemic cardiomyopathy (NIC) cohorts requiring these advanced interventions. Therefore, we sought to extend this literature by comparing echocardiographic parameters, treatment strategies, and the prognosis between matched patients from these cohorts. This is a retrospective matched cohort study. All patients who received a ventricular assist device or OHT at a large Canadian center were reviewed (n = 421; 1988 to 2015) and subjects with clinical and pathologic evidence of AIC were included (n = 17, 4.0%). A comparison cohort with idiopathic NIC from the same database, matched 3:1 for age, gender, ethnicity, and year of heart failure onset was selected. The Mann-Whitney rank-sum and Fisher's exact tests were used for comparisons. Patients with AIC were predominantly women (70.6%) with heart failure diagnosed at age 40.2 ± 15.8 and 8.3 ± 8.9 years after anthracycline treatment. Compared with NIC, no differences were seen in co-morbidities, echocardiographic measures, the proportion of patients receiving a defibrillator, ventricular assist device, or OHT, the incidence of graft failure, and all-cause mortality. In contrast to other studies, AIC was not associated with a higher incidence of right ventricular dysfunction. A greater proportion of patients with AIC developed cancer (recurrence or new primary) post-OHT (21.4% vs 2.3%, p = 0.042). In conclusion, we demonstrate that when matched cohorts of patients with end-stage heart failure secondary to AIC and idiopathic NIC are compared, they are similar with respect to co-morbidities, degree of ventricular dysfunction, and advanced therapeutics used. The prognosis with OHT is also similar.
authors.affiliation: Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Garry R
authors.initials: GR
authors.lastname: Thomas
authors.affiliation: Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, University Health Network, University of Toronto, Toronto, Ontario, Canada; Ted Rogers Center of Excellence in Heart Function, Peter Munk Cardiac Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Michael A
authors.initials: MA
authors.lastname: McDonald
authors.affiliation: Ted Rogers Center of Excellence in Heart Function, Peter Munk Cardiac Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Day
authors.affiliation: Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, University Health Network, University of Toronto, Toronto, Ontario, Canada; Ted Rogers Center of Excellence in Heart Function, Peter Munk Cardiac Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Heather J
authors.initials: HJ
authors.lastname: Ross
authors.affiliation: Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, University Health Network, University of Toronto, Toronto, Ontario, Canada; Ted Rogers Center of Excellence in Heart Function, Peter Munk Cardiac Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Diego H
authors.initials: DH
authors.lastname: Delgado
authors.affiliation: Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, University Health Network, University of Toronto, Toronto, Ontario, Canada; Ted Rogers Center of Excellence in Heart Function, Peter Munk Cardiac Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Filio
authors.initials: F
authors.lastname: Billia
authors.affiliation: Division of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jagdish W
authors.initials: JW
authors.lastname: Butany
authors.affiliation: Ted Rogers Center of Excellence in Heart Function, Peter Munk Cardiac Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Vivek
authors.initials: V
authors.lastname: Rao
authors.affiliation: Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Eitan
authors.initials: E
authors.lastname: Amir
authors.affiliation: Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Philippe L
authors.initials: PL
authors.lastname: Bedard
authors.affiliation: Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, University Health Network, University of Toronto, Toronto, Ontario, Canada; Ted Rogers Center of Excellence in Heart Function, Peter Munk Cardiac Center, University Health Network, University of Toronto, Toronto, Ontario, Canada. Electronic address: dinesh.thavendiranathan@uhn.ca.
authors.forename: Paaladinesh
authors.initials: P
authors.lastname: Thavendiranathan
mesh_terms: D000328:Adult; D018943:Anthracyclines / Q000009:adverse effects* / Q000627:therapeutic use; D009202:Cardiomyopathies / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D006353:Heart-Assist Devices; D006801:Humans; D015994:Incidence; D008297:Male; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D009864:Ontario / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
chemical_list: D018943:Anthracyclines