Abstract
Chemotherapy-induced cardiomyopathy (CCMP) is a significant cause of morbidity and mortality. Compared to cardiomyopathy due to other causes, anthracycline-induced cardiomyopathy is associated with a worse survival. As cancer survival improves, patients with CCMP can be expected to comprise a significant proportion of patients who may require advanced therapies such as inotropic support, cardiac transplantation, or left ventricular assist device (LVAD). Distinct outcomes related to advanced therapies for end-stage heart failure in this patient population may arise due to unique demographic characteristics and comorbidities. We review recent literature regarding the characteristics of patients who have survived cancer undergoing orthotopic heart transplantation and mechanical circulatory support for end-stage heart failure. The challenges and outcomes of advanced therapies for heart failure related specifically to anthracycline-induced cardiomyopathy are emphasized.
Highlights
Chemotherapy-induced cardiomyopathy (CCMP) is a significant cause of morbidity and mortality [1]
Distinct outcomes related to advanced therapies for endstage heart failure in this patient population may arise due to unique demographic characteristics and comorbidities
Future studies are needed to determine if there is an important proportion of patients with a history of anthracycline-induced chemotherapy that are excluded from mechanical circulatory support (MCS) due to small body surface area or, on the other hand, whether lower BSA reflects lower rates of obesity
Summary
Chemotherapy-induced cardiomyopathy (CCMP) is a significant cause of morbidity and mortality [1]. Up to 2–4% of patients with anthracycline-induced cardiomyopathy progress to end-stage heart failure, a proportion of who may require advanced therapies such as inotropic support, orthotopic heart transplantation (OHT), or left ventricular assist device (LVAD) [1]. The resulting histological findings include cytoplasmic vacuolization, myofibril loss and disarray, cellular necrosis and fibrosis [4, 5] It must be noted, that the diagnosis of anthracycline-induced cardiomyopathy in most studies has been presumed based on clinical history and exclusion of other causes. The case illustration introduces several important challenges that clinicians who are caring for patients with endstage heart failure due to cancer treatment face. CCMP and anthracycline-induced cardiomyopathy will be used interchangeably
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