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MADIT-CHIC: CRT beneficial in chemotherapy-induced cardiomyopathy
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SAN FRANCISCO — Among patients with chemotherapy-induced cardiomyopathy eligible for cardiac resynchronization therapy, CRT improved left ventricular function and promoted reverse remodeling, according to the MADIT-CHIC study.
Although patients with chemotherapy-induced cardiomyopathy present with HF and have a 2-year survival rate lower than 50%, there had never been a systemic evaluation of CRT in this cohort, Cardiology Today Editorial Board Member Jagmeet P. Singh, MD, ScM, DPhil, FACC, FHRS, associate chief of cardiology, Roman W. DeSanctis Endowed Chair in Cardiology and founding director of the Resynchronization and Advanced Cardiac Therapeutics Program at Massachusetts General Hospital and professor of medicine at Harvard Medical School, said in an interview at the Heart Rhythm Society Annual Scientific Sessions.
“Even though cardiac resynchronization therapy has been around for several decades, and there have been many randomized clinical trials, the population with chemotherapy-induced cardiomyopathy has not been represented at all,” he told Cardiology Today. “They were not even mentioned in any of those studies. This is an orphan cohort of patients who are seen by an oncologist at one point in time and then later by cardiologists. What this requires is some sort of integrated approach in tracking these patients and better understanding the molecular underpinnings of chemotherapy and heart failure to transform the outcomes in this patient population. These patients do poorly compared with conventional patients with nonischemic cardiomyopathy.”
Singh and colleagues analyzed 30 patients with chemotherapy-induced cardiomyopathy (mean age, 64 years; 87% women) from 12 cardio-oncology programs who were indicated for CRT therapy, were implanted with a CRT device and underwent echocardiography at 6 months. The primary endpoint was change in LV ejection fraction at 6 months.
Most of the patients had been treated with anthracyclines, and all were treated for breast cancer (73%), lymphoma (20%) or sarcoma (7%), Singh said.
LVEF improved a mean of 10.6% at 6 months (standard deviation, 6.6; 95% CI, 8.2-13.9; P < .001), according to the researchers. Improvement was consistent regardless of sex, age, NYHA class, QRS or baseline LVEF.
In addition, LV end-systolic volume decreased 37 mL, LV end-diastolic volume decreased 31.9 mL, left atrial volume decreased 12.6 mL, LV mass decreased 31 g, LV end-systolic diameter decreased 0.6 mm and LV end-diastolic diameter decreased 0.4 mm (P < .001 for all), Singh said.
“We know that reverse remodeling is a predictor of long-term outcomes,” Singh said in an interview. “We can infer that these patients will do better in the long term, but we need studies to track this.” – by Erik Swain
Reference:
Singh JP, et al. LBCT02-04. Presented at: Heart Rhythm Society Annual Scientific Sessions; May 8-11, 2019; San Francisco.
Disclosure: The study was supported by an investigator-initiated research grant from Boston Scientific. Singh reports he consults for Abbott, Back Beat, Biotronik, Boston Scientific, EBR, Impulse Dynamics, Medtronic, Microport and Toray and received research grants from Abbott and Boston Scientific.
Perspective
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Bonnie Ky, MD, MSCE, FACC
This is a small study, but these findings contribute to a growing body of data to support the recovery of LVEF in anthracycline-induced cardiomyopathy, which comprised 76% of this study population. These data speak to the importance of providing guideline-based care to the growing population of cancer survivors.
Generally speaking, until we have specific data in patients with cancer, we have to apply evidence-based guidelines and strategies from CV medicine to the field of cardio-oncology. I think there is a critical need for additional research in patients with cancer, specifically.
While there is a need for larger sample size, greater details about the cancer history and chemotherapy exposure, and longer-term follow-up, I do think these data provide support for CRT in cancer survivors who meet Class I-II indications.
The authors should be commended for conceiving, leading and executing such a study. As the field continues to evolve and grow, there is an imperative need for multidisciplinary collaborations to advance science in this field, between oncologists and cardiologists and between industry and academia.
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