Abstract 18776: Predictors of Left Ventricular Recovery in Anthracycline-Induced Cardiomyopathy.
Introduction: We have shown that anthracycline-induced cardiomyopathy (AC) may be reversible in a significant number of patients. However, clinical and laboratory predictors of recovery are not known.
Objective: To determine clinical and laboratory predictors of left ventricular recovery in patients with AC.
Methods: We analyzed prospectively collected data from 121 cancer patients consecutively admitted with congestive heart failure (HF) and decreased left ventricular ejection fraction (EF) at MD Anderson Cancer Center from 2004 to 2009. All patients had documented normal EF (>55%) either by echocardiography (ECHO) or MUGA prior to chemotherapy. At presentation all patients had a decrease in EF of > 10% points as compared to pre-chemotherapy EF evaluated by blinded readers according to published criteria from ASE. Serial echocardiograms were obtained after initiation of medical therapy for HF. EF recovery was defined as an increase of >10 % points from the lowest EF. We collated clinical, laboratory and ECHO data from all patients. Multivariate analysis was used to determine the predictors for EF recovery and p value was used to determine statistical significance.
Results: In 93 (76%) patients, anthracycline toxicity was determined to be the cause of decreased EF. 68 (64%) patients were female; mean age was 59yrs (range 20–84). Mean EF before initiation of HF treatment was 36% (±9.8). Mean cumulative anthracycline dose was 337 mg/m2 (±248). After a mean of 13 months of therapy with beta-blocker (BB) (90%), ACEI/ARB (68%), and aldosterone antagonist (17%), mean EF increased to 50% (±11.3) (p=0.01) and 59% of patients had EF recovery. In a multivariate model, statistically significant predictors of EF recovery were age <55yrs (OR 3.2), NYHA class 1 or 2 (OR 3.6), time form last dose of anthracycline to diagnosis of HF <12 months (OR 9.6), left atrial volume index (LAVI) <30ml/m2 (OR 1.9), ACEI and BB therapy before diagnosis of HF (OR 3.3). In this population BNP, gender, cumulative anthracycline dose and lowest EF were not predictive of recovery.
Conclusion: In patients with AC, EF recovery is associated with younger age, lower NYHA class and smaller LAVI at time of presentation, BB and ACEI therapy and shorter time from last dose of anthracycline to development of HF.
- © 2010 by American Heart Association, Inc.