Predictive factors for the severity of congestive heart failure after an epirubicin-based treatment for metastatic breast cancer.

Abstract

1124 Background: Patients treated with anthracyclines have a well described risk for developing congestive heart failure (CHF). However, little is known about possible predictive factors for the severity of the CHF acquired. Methods: 125 patients who developed CHF class ≥ II according to New York Heart Association (NYHA) guidelines were included in this retrospective study. The patients were recruited consecutively from 1,097 patients with metastatic breast cancer admitted to Herlev Hospital from November 1983 through November 2003 for an epirubicin-based chemotherapy. No patients treated had a history of cardiac disease before start of epirubicin. Statistics: Univariate analysis based on ordinal logistic regression with NYHA class at time of cardiac disease as the outcome. Results: The median time after cessation of epirubicin to onset of CHF was 3 months (range 0.01 to 66.7 months). The median survival was 7.3 months (range 0.01 to +121.1 months), with eights patients (6.4%) still alive. The distribution of patients in the NYHA class II, III, IV and class ≥ II was: 35 patients (28%), 38 patients (30.4%), 39 patients (31.2%), and 13 patients (10.4%), respectively. Following variables were tested in the univariate analysis: cumulative dose of epirubicin mg/m2, age at the time of epirubicin treatment, previous antihormonal treatment or mediastinal irradiation, and comorbidity with disposition to heart disease. Variables there all previously had been demonstrated as a risk factor for developing CHF after an epirubicin treatment. Moreover, the time from the cessation of epirubicin treatment to the onset of cardiotoxicity and the value of serum-lactatdehydrogenase at the onset of the CHF were included. None of these variables became significant, even at a level of 0.20. Conclusions: No predictive factor for the degree of congestive heart failure (NYHA class) was identified in patients with heart failure due to an epirubicin treatment. Even cumulative epirubicin dose mg/m2, age, comorbidity with disposition to heart disease, or previous mediastinal irradiation had an influence of its own. No significant financial relationships to disclose.