Effect of Mineralocorticoid Receptor Antagonists on Secondary Prevention of Cardiomyopathy Progression in Childhood Cancer Survivors

Abstract

BACKGROUNDThe effect of mineralocorticoid receptor antagonists (MRA) on secondary prevention of late anthracycline-induced cardiomyopathy in childhood cancer survivors is unknown, while other heart failure therapies showed only transient effect. This study sought to assess whether MRA’s may prevent the left ventricular systolic dysfunction caused by latent anthracycline cardiotoxic effects.METHODSCross-sectional, proof of concept study of adult survivors of childhood cancer followed up at the After Cancer Experience and Cardio-Oncology clinics, UT Southwestern Medical Center, after completing anthracycline treatment at least two years prior to this study, in the prior decade. Cross-sectional symptom questionnaires administered during the study and retrospective clinical, laboratory, and imaging data extracted from the electronic medical records were analyzed in 3 groups of patients: on MRA therapy, on heart failure therapy regimen without MRA, and not on therapy for heart failure.RESULTSOf 105 enrolled, 67 patients completed the study. At baseline, the MRA group demonstrated lower LVEF (46% (30-51), n=8 MRA therapy vs 61% (57-63), n=46 no therapy; p<0.01) and higher ESV (59mL (41-90), n=8 MRA therapy vs 36mL (29-43), n=40 no therapy, p<0.05). The MRA group reported a decreased ability to walk one block compared with the non-MRA and no therapy groups (p=0.013). Administration of MRA resulted in a significant improvement in LVEF (52% (34-56), p=0.031 compared to baseline).CONCLUSIONSMRA administration as single drug therapy or in combination with standard of care heart failure therapy may prevent the progression of left ventricular dysfunction in childhood cancer survivors with late anthracycline-induced cardiomyopathy.