Abstract 14361: Anthracycline-Induced Cardiomyopathy Patients Treated with Ventricular Assist Devices Frequently Need Biventricular Support: Data from the INTERMACS Registry
Introduction: Patients previously treated with high dose anthracyclines may develop anthracycline-induced cardiomyopathy (AC) involving both ventricles. The use of mechanical circulatory support (MCS) to treat advanced heart failure in this patient population is important as malignancy may preclude eligibility for cardiac transplantation.
Hypothesis: We hypothesized that AC patients, treated with MCS, have a high incidence of right ventricular (RV) failure requiring biventricular support (BiVAD).
Methods: We analyzed prospectively entered data in the INTERMACS registry and included all patients >19 years of age with the diagnosis of AC between June 2006 and September 2010. Baseline characteristics, implant strategies and type of devices (uni- or biventricular) were compared between AC patients and the overall cohort.
Results: The prevalence of AC was 2% (59 of 2945 patients). Compared to the overall cohort, AC patients were similar in age (52.3 vs. 53.5 years, p=0.48), predominantly female (72.9 vs. 20.4%, p<0.0001), had lower BMI (26.2 vs. 28.7, p=0.005) and diabetes mellitus (23.7 vs. 36.6%, p=0.04). Patients with AC also had higher mean heart rate (99 vs 91/min, p=0.0004), lower mean LVEDD (5.99 vs. 6.85cm, p<0.0001), higher mean right atrial pressures (16.5 vs. 13.5 mmHg, p=0.01) and were more likely to have severe or moderately severe tricuspid regurgitation (62.5 vs. 47.7%, p=0.04), despite other hemodynamic indices being similar. Device strategy was more likely to be destination therapy in AC patients (27.1 vs. 13.4%, p=0.003) with a trend towards more frequent use of biventricular support (Figure 1).
Conclusions: AC patients with end-stage heart failure requiring MCS display more severe right-sided hemodynamic derangements and a strong trend towards increased need for biventricular support. AC candidates for LVAD should be very carefully screened with a though evaluation of RV function.
- © 2011 by American Heart Association, Inc.