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Clinical Trial
. 2010 Jan 19;55(3):213-20.
doi: 10.1016/j.jacc.2009.03.095.

Anthracycline-induced cardiomyopathy: clinical relevance and response to pharmacologic therapy

Daniela Cardinale  1 , Alessandro Colombo, Giuseppina Lamantia, Nicola Colombo, Maurizio Civelli, Gaia De Giacomi, Mara Rubino, Fabrizio Veglia, Cesare Fiorentini, Carlo M Cipolla
Affiliations
Free article
Clinical Trial

Anthracycline-induced cardiomyopathy: clinical relevance and response to pharmacologic therapy

Daniela Cardinale et al. J Am Coll Cardiol. .
Free article

Abstract

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) <or=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.

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