A Matched Cohort Study of Patients With End-Stage Heart Failure from Anthracycline-Induced Cardiomyopathy Requiring Advanced Cardiac Support

Thomas, Garry R.; McDonald, Michael; Day, Jennifer; Ross, Heather J.; Delgado, Diego; Billia, Filio; Butany, Jagdish; Rao, Vivek; Amir, Eitan; Bedard, Philippe L.; Thavendiranathan, Paaladinesh

doi:10.1016/j.amjcard.2016.08.020

Cited by 11 publications

(6 citation statements)

References 19 publications

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“…about the similar burden of arrhythmias in AICM patients with CRT/ICD, compared with both cancer and non‐cancer patients suffering from ischaemic LV dysfunction or IDCM: interestingly, in this recent report, clinical outcomes, including device therapy, OHT, and overall mortality, did not differ between groups, as previously described . A recent retrospective study also showed comparable outcome of VAD and/or OHT in 17 patients with end‐stage AICM vs. 51 patients with IDCM matched for co‐morbidities and severity of LV dysfunction, although a greater proportion of patients in the AICM group developed recurrent or new primary cancer …”

Section: Discussionsupporting

confidence: 77%

Comparison of long‐term outcome in anthracycline‐related versus idiopathic dilated cardiomyopathy: a single centre experience

Fornaro

Olivotto

Rigacci

et al. 2017

European J of Heart Fail

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Section: Discussionsupporting

confidence: 77%

Comparison of long‐term outcome in anthracycline‐related versus idiopathic dilated cardiomyopathy: a single centre experience

Fornaro

Olivotto

Rigacci

et al. 2017

European J of Heart Fail

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Section: Discussionmentioning

confidence: 99%

“…Long-term follow-up studies support the divergent temporal patterns that we observed between chemotherapy initiation and recognition of HF in trastuzumab-treated women and those treated with anthracyclines alone. [16][17][18][19][20][21] Although unselected women with EBC have more cardiovascular risk factors than cancer-free women, 4 EBC patients receiving cardiotoxic chemotherapy have fewer comorbidities than untreated patients. 4,6 Here, we observe that this channeling bias propagates into the baseline characteristics of the EBC-HF cohort, which appeared healthier than cancer-free HF controls.…”

Section: Discussionmentioning

confidence: 99%

Characteristics and Outcomes of Women Developing Heart Failure After Early Stage Breast Cancer Chemotherapy: A Population-Based Matched Cohort Study

Abdel‐Qadir

Tai

Croxford

et al. 2021

Circ: Heart Failure

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Background: The prognosis of heart failure (HF) after early stage breast cancer (EBC) treatment with anthracyclines or trastuzumab is not well-characterized. Methods: Using administrative databases, women diagnosed with HF after receiving anthracyclines or trastuzumab for EBC in Ontario during 2007 to 2017 (the EBC-HF cohort) were categorized by cardiotoxic exposure (anthracycline alone, trastuzumab alone, sequential therapy with both agents) and matched on age with ≤3 cancer-free HF controls to compare baseline characteristics. To study prognosis after HF onset, we conducted a second match on age plus important HF prognostic factors. The cumulative incidence function was used to describe risk of hospitalization or emergency department visits (hospital presentations) for HF and cardiovascular death. Results: A total of 804 women with EBC developed HF after anthracyclines (n=312), trastuzumab (n=112), or sequential therapy (n=380); they had significantly fewer comorbidities than 2411 age-matched HF controls. After the second match, the anthracycline-HF cohort had a similar 5-year incidence of HF hospital presentations (16.5% [95% CI, 12.0%–21.7%]) as controls (17.1% [95% CI, 14.4%–20.1%]); the 5-year incidence was lower than matched controls for the trastuzumab-HF (9.7% [95% CI, 4.7%–16.9%]; controls 16.4% [95% CI, 12.1%–21.3%]; P =0.03) and sequential-HF cohorts (2.7% [95% CI, 1.4%–4.8%]; controls 10.8% [95% CI, 8.9%–13.0%]; P <0.001). At 5 years, the incidence of cardiovascular death was 2.9% (95% CI, 1.2%–5.9%) in the anthracycline-HF cohort vs. 9.5% (95% CI, 6.9%–12.6%) in controls, and 1.7% (0.6%–3.7%) for women developing HF after trastuzumab vs. 4.3% (95% CI, 3.1–5.8%) for controls. Conclusions: Women developing HF after cardiotoxic EBC chemotherapy have fewer comorbidities than cancer-free women with HF; trastuzumab-treated women who develop HF have better prognosis than matched HF controls.

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“…Survival was similar to other causes of ventricular dysfunction. However, in one study, there was a higher need for subsequent right ventricular support in the anthracycline-induced cardiomyopathy group [ 141 , 142 , 143 , 144 ]. Data in pediatric patients are currently limited to a single case report [ 145 ].…”

Section: Therapeutic Approachesmentioning

confidence: 99%

Current State of Pediatric Cardio-Oncology: A Review

2022

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The landscape of pediatric oncology has dramatically changed over the course of the past several decades with five-year survival rates surpassing 80%. Anthracycline therapy has been the cornerstone of many chemotherapy regimens for pediatric patients since its introduction in the 1960s, and recent improved survival has been in large part due to advancements in chemotherapy, refinement of supportive care treatments, and development of novel therapeutics such as small molecule inhibitors, chimeric antigen receptor T-cell therapy, and immune checkpoint inhibitors. Unfortunately, many cancer-targeted therapies can lead to acute and chronic cardiovascular pathologies. The range of cardiotoxicity can vary but includes symptomatic or asymptotic heart failure, arrhythmias, coronary artery disease, valvar disease, pericardial disease, hypertension, and peripheral vascular disease. There is lack of data guiding primary prevention and treatment strategies in the pediatric population, which leads to substantial practice variability. Several important future research directions have been identified, including as they relate to cardiac disease, prevention strategies, management of cardiovascular risk factors, risk prediction, early detection, and the role of genetic susceptibility in development of cardiotoxicity. Continued collaborative research will be key in advancing the field. The ideal model for pediatric cardio-oncology is a proactive partnership between pediatric cardiologists and oncologists in order to better understand, treat, and ideally prevent cardiac disease in pediatric oncology patients.

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A Matched Cohort Study of Patients With End-Stage Heart Failure from Anthracycline-Induced Cardiomyopathy Requiring Advanced Cardiac Support

Cited by 11 publications

References 19 publications

Comparison of long‐term outcome in anthracycline‐related versus idiopathic dilated cardiomyopathy: a single centre experience

Comparison of long‐term outcome in anthracycline‐related versus idiopathic dilated cardiomyopathy: a single centre experience

Characteristics and Outcomes of Women Developing Heart Failure After Early Stage Breast Cancer Chemotherapy: A Population-Based Matched Cohort Study

Current State of Pediatric Cardio-Oncology: A Review

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