Abstract

BackgroundAnthracycline-induced cardiac dysfunction (ACD) is a notorious side effect of anticancer treatment. It has been described as a phenomenon of a continuous progressive decline of cardiac function, eventually leading to dilated cardiomyopathy (DCM). This progressive nature suggests that patients with a delayed ACD diagnosis have greater compromise of cardiac function and more adverse remodeling, with a poor response to heart failure (HF) treatment. This study aimed to delineate the impact of a delayed ACD diagnosis on echocardiographic characteristics and response to HF treatment.Methods and resultsFrom the population of our cardio-oncology outpatient clinic, 92 ACD patients were included in this study (age 51.6 ± 16.2 years, median cumulative anthracycline dose 329 [200–329] mg/m2), and a median follow-up of 25.0 [9.6–37.2] months after ACD diagnosis. Median time to ACD diagnosis for patients diagnosed early (< 1 year) and late (> 1 year) was 4.0 vs. 47.7 months respectively. There were no echocardiographic differences between patients diagnosed early vs. late (LVEF 43.6 ± 4.9% vs. 43.0 ± 6.2% and iEDV 63.6 vs. 62.9 mL/m2). Eighty-three percent of patients presented with mild LV dysfunction and in 79% the LV was not dilated. Patients diagnosed early were more likely to have (partial) recovery of cardiac function upon HF treatment initiation (p = 0.015).ConclusionsIn the setting of a cardio-oncology outpatient clinic, patients with ACD presented with a hypokinetic non-dilated cardiomyopathy, rather than typical DCM. Timing of ACD diagnosis did not impact HF disease severity. However, in patients receiving an early diagnosis, cardiac function was more likely to recover upon HF treatment.

Highlights

  • Anthracyclines are potent antineoplastic drugs that constitute a cornerstone in the treatment of sarcomas, breast cancer and hematological malignancies

  • In patients receiving an early diagnosis, cardiac function was more likely to recover upon heart failure (HF) treatment

  • The underlying cause for the impaired left ventricular (LV) dysfunction was deemed not related to anthracyclines

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Summary

Introduction

Anthracyclines are potent antineoplastic drugs that constitute a cornerstone in the treatment of sarcomas, breast cancer and hematological malignancies. It can be postulated that over time, patients with ACD develop progressive systolic dysfunction with dilated compartments, as is the case in patients with familial DCM, long lasting left-sided valvular disease or hypertension The aim of this consecutive cohort study was to (1) evaluate the impact of a delayed diagnosis (> 1 year after anthracycline containing treatment) on echocardiographic characteristics and (2) assess the influence of timing of diagnosis on HF treatment response. It has been described as a phenomenon of a continuous progressive decline of cardiac function, eventually leading to dilated cardiomyopathy (DCM) This progressive nature suggests that patients with a delayed ACD diagnosis have greater compromise of cardiac function and more adverse remodeling, with a poor response to heart failure (HF) treatment. This study aimed to delineate the impact of a delayed ACD diagnosis on echocardiographic characteristics and response to HF treatment

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