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Risk for bleeding, right ventricular failure higher with chemotherapy-induced cardiomyopathy
Patients with chemotherapy-induced cardiomyopathy who undergo mechanical circulatory support have a similar survival rate as those with end-stage HF treated similarly, but increased risk for bleeding and need for right ventricular assist device support, according to new data collected from the INTERMACS database.
Researchers studied 3,812 patients with chemotherapy-induced cardiomyopathy who underwent mechanical circulatory support between June 2006 and March 2011. They compared characteristics, outcomes and survival rates of ischemic cardiomyopathy, nonischemic cardiomyopathy and chemotherapy-induced cardiomyopathy.
“Patients with end-stage HF as a result of chemotherapy-induced cardiomyopathy from anthracyclines are often precluded from heart transplantation because of a history of cancer,” the researchers wrote. “In such patients, durable mechanical circulatory support may offer an important chance for life prolongation. Yet, there are no data to support the use of mechanical circulatory support in this increasingly prevalent group of patients.”
Patients with chemotherapy-induced cardiomyopathy (n=75) were more frequently women (72% vs. 24% with nonischemic cardiomyopathy and 13% with ischemic cardiomyopathy) and were more likely to receive mechanical circulatory support as a destination therapy (33% vs. 14% with nonischemic cardiomyopathy and 23% with ischemic cardiomyopathy).
Bleeding risk was significantly higher in patients with chemotherapy-induced cardiomyopathy (P<.0001). These patients also required more frequent right ventricular assist device support (19% vs. 11% with nonischemic cardiomyopathy vs. 6% with ischemic cardiomyopathy; P=.006). No total artificial hearts were implanted in patients with chemotherapy-induced cardiomyopathy as a bridge to transplantation. Additionally, concomitant surgery was more common in patients with chemotherapy-induced cardiomyopathy (48%) compared with patients with nonischemic cardiomyopathy (36.5%; P=.03) or ischemic cardiomyopathy (36%; P=.04). Tricuspid repair was the most common concomitant surgery.
Device malfunction, time to infection, neurological dysfunction and right ventricular failure events were similar among the three patient groups. The researchers also reported no significant differences in rates of transplantation and recovery.
Survival was similar between patients with chemotherapy-induced cardiomyopathy and the other types: 25% of patients with chemotherapy-induced cardiomyopathy died vs. 19% with nonischemic cardiomyopathy and 22% with ischemic cardiomyopathy. Among patients with chemotherapy-induced cardiomyopathy, survival did not differ significantly according to patient profile (P=.87) or whether treatment was intended as a destination therapy or bridge to transplant (P=.16). However, researchers said patients who required biventricular assist device support had significantly worse survival than patients with chemotherapy-induced cardiomyopathy who required only left ventricular assist device support (P=.0007).
“This is the first report to date of a series of [chemotherapy-induced cardiomyopathy patients] treated with [mechanical circulatory support],” the researchers wrote.
“We have found that survival of [chemotherapy-induced cardiomyopathy] patients treated with [mechanical circulatory support] is similar to that of other [mechanical circulatory support patients], but that [chemotherapy-induced cardiomyopathy] is associated with a significantly higher risk of [right ventricular] failure and need for [right ventricular assist device] support. Therefore, while validating the usefulness of this technology for [chemotherapy-induced cardiomyopathy] patients, we also demonstrated the prevalence of biventricular involvement in [chemotherapy-induced cardiomyopathy]. … Further studies are needed to better understand the nature of [chemotherapy-induced cardiomyopathy] and to confirm our findings,” they wrote.
Disclosure: See the full study for a list of the researchers’ relevant financial disclosures.