CLINICAL RESEARCH: HEART FAILURE
Anthracycline-Induced CardiomyopathyClinical Relevance and Response to Pharmacologic Therapy
Daniela Cardinale, MD, PhD*,*,
Alessandro Colombo, MD*,
Giuseppina Lamantia, MD*,
Nicola Colombo, MD*,
Maurizio Civelli, MD*,
Gaia De Giacomi, MD*,
Mara Rubino, MD ,
Fabrizio Veglia, PhD,
Cesare Fiorentini, MD and
Carlo M. Cipolla, MD*
* Cardiology Unit, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
Centro Cardiologico Monzino, Istituto di Ricovero e Cura a Carattere Scientifico, Institute of Cardiology, University of Milan, Milan, Italy
Manuscript received January 2, 2009;
revised manuscript received March 10, 2009,
accepted March 10, 2009.
* Reprint requests and correspondence: Dr. Daniela Cardinale, Cardiology Unit, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy (Email: daniela.cardinale{at}ieo.it).
Objectives: The purpose of this study was to evaluate the clinical relevance of anthracycline-induced cardiomyopathy (AC-CMP) and its response to heart failure (HF) therapy.
Background: The natural history of AC-CMP, as well as its response to modern HF therapy, remains poorly defined. Hence, evidence-based recommendations for management of this form of cardiomyopathy are still lacking.
Methods: We included in the study 201 consecutive patients with a left ventricular ejection fraction (LVEF)  45% due to AC-CMP. Enalapril and, when possible, carvedilol were promptly initiated after detection of LVEF impairment. LVEF was measured at enrollment, every month for the first 3 months, every 3 months during the first 2 following years, and every 6 months afterward (mean follow-up 36 ± 27 months). Patients were considered responders, partial responders, or nonresponders according to complete, partial, or no recovery in LVEF, respectively. Major adverse cardiac events during follow-up were also evaluated.
Results: Eighty-five patients (42%) were responders; 26 patients (13%) were partial responders, and 90 patients (45%) were nonresponders. The percentage of responders progressively decreased as the time from the end of chemotherapy to the start of HF treatment increased; no complete recovery of LVEF was observed after 6 months. Responders showed a lower rate of cumulative cardiac events than partial and nonresponders (5%, 31%, and 29%, respectively; p < 0.001).
Conclusions: In cancer patients developing AC-CMP, LVEF recovery and cardiac event reduction may be achieved when cardiac dysfunction is detected early and a modern HF treatment is promptly initiated.
Key Words: anthracycline-induced cardiomyopathy • left ventricular ejection fraction • chemotherapy • enalapril • carvedilol • heart failure
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Abbreviations and Acronyms
| | AC = anthracycline | | ACEI = angiotensin-converting enzyme inhibitor | | CMP = cardiomyopathy | | HF = heart failure | | LVEF = left ventricular ejection fraction | | NYHA = New York Heart Association |
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