Heart Failure Therapies for End-Stage Chemotherapy–Induced Cardiomyopathy

Abstract

With ongoing advancements in cancer-related treatments, the number of cancer survivors continues to grow globally, with numbers in the United States predicted to reach 18 million by 2020. As a result, it is expected that a greater number of patients will present with chemotherapy-related side effects. One entity in particular, chemotherapy-related cardiomyopathy (CCMP), is a known cardiotoxic manifestation associated with agents such as anthracyclines, trastuzumab, and tyrosine kinase inhibitors. Although such effects have been described in the medical literature for decades, concrete strategies for screening, prevention, and management of CCMP continue to be elusive owing to limited studies. Late recognition of CCMP is associated with a poorer prognosis, including a lack of clinical response to pharmacologic therapy, and end-stage heart failure. A number of advanced cardiac therapies, including cardiac resynchronization therapy, ventricular assist devices, and orthotopic cardiac transplantation, are available to for end-stage heart failure; however, the role of these therapies in CCMP is unclear. In this review, management of end-stage CCMP with the use of advanced therapies and their respective effectiveness are discussed, as well as clinical characteristics of patients undergoing these treatments. The relative paucity of data in this field highlights the importance and need for larger-scale longitudinal studies and long-term registries tracking the outcomes of cancer survivors who have received cardiotoxic cancer therapy to determine the overall incidence of end-stage CCMP, as well as prognostic factors that will ultimately guide such patients toward receiving appropriate end-stage care.

Incidence, Diagnosis, and Treatment of Cardiac Toxicity From Trastuzumab in Patients With Breast Cancer

“…These trials have also not been powered to assess clinical outcomes, instead measuring LVEF as a primary endpoint. It has been questioned if the observed reduction in LVEF decline is of clinical relevance (72). …”

“…ACEIs/ARBs and BBs are appropriate first-line agents followed by loop diuretics, hydralazine-nitrates, and aldosterone antagonists per the ACC/AHA guidelines (79). Newer agents may also be of benefit such as the neprilysin-angiotensin receptor antagonist, sacubitril-valsartan, and the If channel inhibitor, ivabradine (72). For advanced heart failure, cardiac resynchronization therapy, mechanical circulatory support, and orthotopic heart transplant may be of benefit (81).…”

“…For advanced heart failure, cardiac resynchronization therapy, mechanical circulatory support, and orthotopic heart transplant may be of benefit (81). However, data are scant pertaining to the impact of traditional heart failure treatments in patients who develop cardiotoxicity from trastuzumab (72). …”

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

“…In the last decade, the field of cardio‐oncology has rapidly gained clinical relevance and the resulting, widespread awareness has led to the adoption of preventive measures such as low‐dose chemotherapy regimens and early cardioprotective treatment . Yet, surprisingly little information is known about the contemporary outcome of chemotherapy‐related heart diseases, including its most prevalent form: anthracycline‐induced cardiomyopathy (AICM) . AICM, defined as a > 10% reduction in left ventricular ejection fraction (LVEF), to levels <50%, compared with pre‐treatment values, is associated with rates of heart failure (HF) that range from 5% to almost 26%, depending on the population and duration of follow‐up .…”

MicroRNA-497 Inhibits Cardiac Hypertrophy by Targeting Sirt4

“…World Health Organization announced that a total number of 17,500,000 people die from heart failure each year, which account for 30% of the death case [1]. Cardiac hypertrophy is a major determinant for the development of heart failure and is associated with a higher risk of sudden cardiac death (SCD) [2].…”