학술논문
Cardiac resynchronisation therapy in anthracycline-induced cardiomyopathy.
Document Type
Academic Journal
Author
Patel D; Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA pateld2@ccf.org.; Kumar A; Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.; Moennich LA; Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.; Trulock K; Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.; Nemer DM; Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.; Donnellan E; Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.; Il'Giovine ZJ; Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.; Martyn T; Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.; Callahan TD; Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.; Hussein AA; Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.; Tarakji KG; Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.; Kanj M; Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.; Cantillon DJ; Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.; Baranowski B; Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.; Starling RC; Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.; Tang WHW; Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.; Wazni OM; Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.; Varma N; Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.; Wilkoff BL; Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.; Rickard J; Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Source
Publisher: BMJ Pub. Group Country of Publication: England NLM ID: 9602087 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1468-201X (Electronic) Linking ISSN: 13556037 NLM ISO Abbreviation: Heart Subsets: MEDLINE
Subject
Language
English
Abstract
Introduction: Chemotherapy-induced cardiomyopathy has been increasingly recognised as patients are living longer with more effective treatments for their malignancies. Anthracyclines are known to cause left ventricular (LV) dysfunction. While heart failure medications are frequently used, some patients may need consideration for device-based therapies such as cardiac resynchronisation therapy (CRT). However, the role of CRT in anthracycline-induced cardiomyopathy (AIC) is not well understood.
Methods: We performed a retrospective review of all patients undergoing CRT implantation at our centre from 2003 to 2019 with a diagnosis of AIC. The LV remodelling and survival outcomes of this population were obtained and then compared with consecutive patients with other aetiologies of non-ischaemic cardiomyopathy (NICM).
Results: A total of 34 patients underwent CRT implantation with a diagnosis of AIC with a mean age of 60.5±12.7 years, left ventricular ejection fraction (LVEF) of 21.7%±7.4%, and 11.3±7.5 years and 10.2±7.4 years from cancer diagnosis and last anthracycline exposure, respectively. At 9.6±8.1 months after CRT implantation, there was an increase of LVEF from 21.8%±7.6% to 30.4%±13.0% (p<0.001). Patients whose LVEF increased by at least 10% post-CRT implant (42.5% of cohort) survived significantly longer than patients who failed to improve their LVEF by that amount (p=0.01). A propensity matched analysis between patients with AIC and 369 consecutive patients with other aetiologies of NICM who underwent CRT implantation during the same period revealed no significant differences in improvement in LVEF or long-term survival.
Conclusions: Patients with AIC undergo LV remodelling with CRT at rates similar to other aetiologies of NICM. Furthermore, AIC post-CRT responders have a favourable long-term mortality compared with non-responders.
Competing Interests: Competing interests: TC: consultant, Biotronik. KGT: consulting and honoraria from Medtronic and Spectranetics Corporation; advisory board, Medtronic and AliveCor. DC: consultant, Abbott and Boston Scientific. OW: Honoraria Spectranetics. NV: consultant/honoraria from St. Jude Medical, Boston Scientific, Biotronik and Medtronic. BLW: honoraria/consultant fees from Abbott, Medtronic and Philipps. JR: honoraria/consultant fees from Abbott and Medtronic. All other authors have no disclosures to report.
(© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
Methods: We performed a retrospective review of all patients undergoing CRT implantation at our centre from 2003 to 2019 with a diagnosis of AIC. The LV remodelling and survival outcomes of this population were obtained and then compared with consecutive patients with other aetiologies of non-ischaemic cardiomyopathy (NICM).
Results: A total of 34 patients underwent CRT implantation with a diagnosis of AIC with a mean age of 60.5±12.7 years, left ventricular ejection fraction (LVEF) of 21.7%±7.4%, and 11.3±7.5 years and 10.2±7.4 years from cancer diagnosis and last anthracycline exposure, respectively. At 9.6±8.1 months after CRT implantation, there was an increase of LVEF from 21.8%±7.6% to 30.4%±13.0% (p<0.001). Patients whose LVEF increased by at least 10% post-CRT implant (42.5% of cohort) survived significantly longer than patients who failed to improve their LVEF by that amount (p=0.01). A propensity matched analysis between patients with AIC and 369 consecutive patients with other aetiologies of NICM who underwent CRT implantation during the same period revealed no significant differences in improvement in LVEF or long-term survival.
Conclusions: Patients with AIC undergo LV remodelling with CRT at rates similar to other aetiologies of NICM. Furthermore, AIC post-CRT responders have a favourable long-term mortality compared with non-responders.
Competing Interests: Competing interests: TC: consultant, Biotronik. KGT: consulting and honoraria from Medtronic and Spectranetics Corporation; advisory board, Medtronic and AliveCor. DC: consultant, Abbott and Boston Scientific. OW: Honoraria Spectranetics. NV: consultant/honoraria from St. Jude Medical, Boston Scientific, Biotronik and Medtronic. BLW: honoraria/consultant fees from Abbott, Medtronic and Philipps. JR: honoraria/consultant fees from Abbott and Medtronic. All other authors have no disclosures to report.
(© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)