Abstract 18687: The Clinical Characteristics and Prognosis of Patients With Anthracycline-Induced Cardiomyopathy
Background: Anthracyclines are required to treat many solid organ and hematological malignancies but can be associated with cardiomyopathy (AICM). This may present as acute toxicity or as ventricular dysfunction years after exposure. We sought to describe the clinical features, time-lapse left ventricular ejection fraction (LVEF), therapeutic strategies, and mortality in AICM.
Methods: This is a retrospective cohort study at a large Canadian heart failure (HF) center. Patients with a clinical diagnosis of AICM managed by our HF program were reviewed (N=102; Feb 2001 - 2016). Clinical data were obtained from patient electronic medical records. All echocardiograms and cardiac interventions were performed at our institution.
Results: The clinical onset of HF occurred at age 51.1 ± 15.7 years. AICM developed in 12.2% during chemotherapy and at a median 1.8 (IQR 0.5-7.5) years among those diagnosed subsequent to treatment. The primary malignancies included breast cancer (41.8%) followed by hematologic malignancies (37.3%). AICM patients were predominantly female (69.6%), Caucasian (76.5%), and had relatively low rates of cardiovascular comorbidities. At the time of diagnosis, the LVEF was 36.4 ± 13.5%, with subsequent measures outlined in Table 1. Among patients with cardiac imaging at 1 year after diagnosis, only 33.3% had a LVEF recovery of ≥ 15%. Additionally, 25.5% of patients received a defibrillator (ICD/CRT-D), 7.8% a ventricular assist device (VAD), and 13.7% a heart transplant over a median follow-up period of 7.6 (IQR 4.4-10.1) years. The 5 year all-cause mortality among AICM patients was 27.4%.
Conclusions: The majority of our patients developed AICM after the completion of cancer therapy. Ventricular dysfunction was irreversible in a majority and many required advanced cardiac therapy. Despite these interventions, mortality rates were high. Our data emphasizes the importance of post-treatment surveillance and strategies to prevent the onset of AICM.
Author Disclosures: G.R. Thomas: None. V. Siu: None. M.A. McDonald: None. H.J. Ross: None. D.H. Delgado: None. F. Billia: None. V. Rao: None. E. Amir: None. P. Thavendiranathan: None.
- © 2016 by American Heart Association, Inc.