Case Series: Recovery of Chemotherapy-Related Acute Heart Failure by the Combined Use of Sacubitril Valsartan and Wearable Cardioverter Defibrillator: A Novel Winning Combination in Cardio-Oncology

Abstract

Effective anticancer treatments have dramatically improved the outcome of patients with cancer, but cardiac toxicity reduces their clinical efficacy in a non-negligible percentage of patients. Sacubitril/valsartan is a new paradigm in the treatment of chronic heart failure, with a reduced ejection fraction due to the enhancement of natriuretic peptides' properties when coupled with a blocking effect on the angiotensin II type 1 (AT1) receptors. As with other clinical conditions of heart failure with potentially reversible declines in cardiac function, a wearable cardioverter defibrillator (WCD) is a valid tool for protection against sudden death until recovery occurs. We report a case series of four patients with chemotherapy-related acute cardiac failure with severely reduced cardiac function. They were successfully treated with sacubitril/valsartan while being protected from malignant arrhythmias using a wearable cardioverter defibrillator until the recovery of cardiac function. Sacubitril/valsartan was confirmed to be effective in anthracycline-related cardiac toxicity and the wearable cardioverter defibrillator should be considered as a support tool even in the oncology patient.

Effect of angiotensin receptor-neprilysin inhibitor treatment on erectile dysfunction in heart failure with a reduced ejection fraction

“…According to some published studies, ARNI treatment caused partial left ventricular EF elevation in all mildly reduced EF HF patients, regardless of etiology [22]. In the study of Canale et al, it was shown that ARNI treatment caused recovery of the chemotherapy-related advanced mild EF in 4 patients, with a possible antioxidant mechanism [23]. In our study, after 6 months of ARNI treatment, no significant positive change was observed in EF values according to the initial measurements.…”

Sacubitril-valsartan: Hope or hype in the battle against cardiotoxicity due to cancer treatment? Authors’ reply

“…This has been indirectly confirmed by the observations of Canale et al [4], who used ARNI in a group of patients in whom, due to the cardiotoxicity of various chemotherapy regimens, it was necessary to use the wearable cardioverter defibrillator (WCD) [4]. It resulted in protecting patients against life-threatening ventricular tachyarrhythmias in the period of low LVEF, as well as in significant improvement in LVEF seen in the long term.…”

Cancer treatment-related cardiotoxicity: a focus on sacubitril/valsartan

“…Studies which evaluated sacubitril/valsartan in the context of CTRCD were reviewed in Table 3 [78][79][80][81][82][83][84][85][86][87][88] . A retrospective case study described two anthracycline-related cardiomyopathy survivors with HFrEF who were treated with sacubitril/valsartan with success after poor responses to conventional evidence-based drug treatment [78] .…”

“…Both subjects exhibited fair recovery of NYHA functional class and normalization of NT-proBNP concentration as well as no rehospitalization for heart failure [78] . Canale et al [79] reported a case series of four patients with CTRCD and severe HFrEF. All patients were managed with sacubitril/valsartan with success while being combatting malignant ventricular arrhythmias by wearing an automatic defibrillator until heart function recovery [79] .…”