Early- and late anthracycline-induced cardiac dysfunction: echocardiographic characterization and response to heart failure therapy

Cardio-Oncology

Marijke Linschoten¹  Maarten J. Cramer¹  Janine A. M. Kamphuis¹  Arco J. Teske¹  Folkert W. Asselbergs²  Pieter A. Doevendans³ 

[1] Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, PO Box 85500, E03.511, 3508 GA, Utrecht, The Netherlands;Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, PO Box 85500, E03.511, 3508 GA, Utrecht, The Netherlands;Health Data Research UK and Institute of Health Informatics, University College London, London, UK;Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK;Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, University of Utrecht, PO Box 85500, E03.511, 3508 GA, Utrecht, The Netherlands;Netherlands Heart Institute, Utrecht, The Netherlands;Central Military Hospital, Utrecht, The Netherlands;

关键词: Heart failure;    Anthracyclines;    Cardiac dysfunction;    Cardiac effects of cancer treatment;   

DOI  :  10.1186/s40959-020-00079-3

来源: Springer

【 摘 要 】

BackgroundAnthracycline-induced cardiac dysfunction (ACD) is a notorious side effect of anticancer treatment. It has been described as a phenomenon of a continuous progressive decline of cardiac function, eventually leading to dilated cardiomyopathy (DCM). This progressive nature suggests that patients with a delayed ACD diagnosis have greater compromise of cardiac function and more adverse remodeling, with a poor response to heart failure (HF) treatment. This study aimed to delineate the impact of a delayed ACD diagnosis on echocardiographic characteristics and response to HF treatment.Methods and resultsFrom the population of our cardio-oncology outpatient clinic, 92 ACD patients were included in this study (age 51.6 ± 16.2 years, median cumulative anthracycline dose 329 [200–329] mg/m2), and a median follow-up of 25.0 [9.6–37.2] months after ACD diagnosis. Median time to ACD diagnosis for patients diagnosed early (< 1 year) and late (> 1 year) was 4.0 vs. 47.7 months respectively. There were no echocardiographic differences between patients diagnosed early vs. late (LVEF 43.6 ± 4.9% vs. 43.0 ± 6.2% and iEDV 63.6 vs. 62.9 mL/m2). Eighty-three percent of patients presented with mild LV dysfunction and in 79% the LV was not dilated. Patients diagnosed early were more likely to have (partial) recovery of cardiac function upon HF treatment initiation (p = 0.015).ConclusionsIn the setting of a cardio-oncology outpatient clinic, patients with ACD presented with a hypokinetic non-dilated cardiomyopathy, rather than typical DCM. Timing of ACD diagnosis did not impact HF disease severity. However, in patients receiving an early diagnosis, cardiac function was more likely to recover upon HF treatment.

【 授权许可】

CC BY