Abstract 14921: Value of Left Ventricular Ejection Fraction and Its Changes for the Prediction of Symptomatic Heart Failure in Patients Treated by Anthracyclines
Background: Patients treated with anthracyclines (AC) are usually monitored for cardiotoxicity using left ventricular ejection fraction (LVEF). The absolute value or the degree of change in LVEF predictive of symptomatic heart failure (HF) is debated. The objective of the study was to evaluate LVEF in the prediction of symptomatic HF and cardiac death in patients treated with AC.
Methods: Patients > 18yo treated with AC at a single center (2001-2012) were selected. Eligible patients had to have one or more echocardiograms (echos) including one before the start of AC. The primary endpoint was the occurrence of cardiac events (CE) defined as NYHA class III or IV HF, cardiac arrest or cardiac death. Baseline and post AC EF and changes in EF were analyzed in univariate Cox regression models and contingence models.
Results: Of 2285 eligible patients, 870 had baseline and post AC echos. Median age prior to AC treatment was 53 yo [range 43-64], the median cumulative dose of AC 213 mg/m2 [139-262], and the median follow-up was 620 days [175-1542]. The second echo was done at a median of 110 days after the initiation of AC [51-335]. Sixty-five patients (2.8%) developed CE. Baseline EF, the nadir of the post AC EF, and the degree of change in EF predicted the occurrence of CE both by continuous and categorical analysis (all p<0.001, Table). Patients with post AC EFs between 55-60% had a greater CE rate than patients with EFs>60% (P<0.02, Table). Patients with a decrease of 5-10 EF points had higher CE rates than patients with a change of EF<5 even if their baseline EF was >60 thus their EF did not decrease below 50 (2.3% vs. 0.3%, P<0.05).
Conclusion: Baseline EF, post AC EF and changes in EF between baseline and post AC predict the occurrence of symptomatic HF and cardiac death in patients treated by AC. Post AC EF of 55-60% and a decrease of 5-10 EF points even with a baseline EF of 60% are associated with slightly higher CE rates than higher EFs or decreases of <5 EF points, and should be closely monitored.
- © 2013 by American Heart Association, Inc.