Author + information
- Received January 2, 2009
- Revision received March 10, 2009
- Accepted March 10, 2009
- Published online January 19, 2010.
- 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*
- ↵*Reprint requests and correspondence:
Dr. Daniela Cardinale, Cardiology Unit, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
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.
- anthracycline-induced cardiomyopathy
- left ventricular ejection fraction
- heart failure
Continuing Medical Education (CME) is available for this article.
This study was funded by the European Institute of Oncology.
- Received January 2, 2009.
- Revision received March 10, 2009.
- Accepted March 10, 2009.
- American College of Cardiology Foundation