Response to Letter Regarding Article, “Prevention of High-Dose Chemotherapy–Induced Cardiotoxicity in High-Risk Patients by Angiotensin-Converting Enzyme Inhibition”

Abstract

HomeCirculationVol. 115, No. 24Response to Letter Regarding Article, “Prevention of High-Dose Chemotherapy–Induced Cardiotoxicity in High-Risk Patients by Angiotensin-Converting Enzyme Inhibition” Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBResponse to Letter Regarding Article, “Prevention of High-Dose Chemotherapy–Induced Cardiotoxicity in High-Risk Patients by Angiotensin-Converting Enzyme Inhibition” Daniela Cardinale, Alessandro Colombo, Maria T. Sandri, Giuseppina Lamantia, Nicola Colombo, Maurizio Civelli, Giovanni Martinelli and Carlo M. Cipolla Fabrizio Veglia and Cesare Fiorentini Daniela CardinaleDaniela Cardinale Cardiology and Laboratory Medicine Units, Haemato-Oncology Division, European Institute of Oncology, IRCCS, Milan, Italy Search for more papers by this author , Alessandro ColomboAlessandro Colombo Cardiology and Laboratory Medicine Units, Haemato-Oncology Division, European Institute of Oncology, IRCCS, Milan, Italy Search for more papers by this author , Maria T. SandriMaria T. Sandri Cardiology and Laboratory Medicine Units, Haemato-Oncology Division, European Institute of Oncology, IRCCS, Milan, Italy Search for more papers by this author , Giuseppina LamantiaGiuseppina Lamantia Cardiology and Laboratory Medicine Units, Haemato-Oncology Division, European Institute of Oncology, IRCCS, Milan, Italy Search for more papers by this author , Nicola ColomboNicola Colombo Cardiology and Laboratory Medicine Units, Haemato-Oncology Division, European Institute of Oncology, IRCCS, Milan, Italy Search for more papers by this author , Maurizio CivelliMaurizio Civelli Cardiology and Laboratory Medicine Units, Haemato-Oncology Division, European Institute of Oncology, IRCCS, Milan, Italy Search for more papers by this author , Giovanni MartinelliGiovanni Martinelli Cardiology and Laboratory Medicine Units, Haemato-Oncology Division, European Institute of Oncology, IRCCS, Milan, Italy Search for more papers by this author and Carlo M. CipollaCarlo M. Cipolla Cardiology and Laboratory Medicine Units, Haemato-Oncology Division, European Institute of Oncology, IRCCS, Milan, Italy Search for more papers by this author Fabrizio VegliaFabrizio Veglia Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy Search for more papers by this author and Cesare FiorentiniCesare Fiorentini Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy Search for more papers by this author Originally published19 Jun 2007https://doi.org/10.1161/CIRCULATIONAHA.107.695619Circulation. 2007;115:e638We thank Dr Khan and colleagues for their interest in our work.1 Twenty-five patients of the control group exhibited decreased left ventricular ejection fraction below the normal limit value and developed overt heart failure in 9 cases during the 1-year follow-up. In all these patients, standard therapy for heart failure was started when symptoms occurred or when cardiac impairment was detected (as an average 6.8±3.8 months after chemotherapy). Treatment included enalapril and carvedilol at the maximum tolerated doses (13 patients tolerated the combination of the 2 drugs), as recommended by the International Cardiologic Guidelines. In these patients, no significant improvement in left ventricular ejection fraction was observed during the observation period. A longer follow-up is possibly required to define the long-term clinical impact of treatment in this population.Several previous reports have evaluated the response to heart failure therapy in patients with chemotherapy-induced cardiomyopathy but with conflicting results,2–3 although the combination of angiotensin-converting enzyme inhibitors and β-blockers has shown the most favorable effect.4 Nevertheless, in these studies, cardiologic treatment was started only after the clinical or instrumental evidence of heart failure, often many years after chemotherapy.In our study, the approach was completely different. We started enalapril long before a possible decline in left ventricular ejection fraction was evident (left ventricular ejection fraction was 61±3% and 62±4% in the 2 study groups at randomization). In fact, troponin I increase notably anticipates the development of cardiotoxicity.5 These findings highlight the strategic importance of an early preventive treatment, addressed only to those patients who show a subclinical evidence of cardiac injury after chemotherapy as revealed by troponin I.DisclosuresNone.1 Cardinale D, Colombo A, Sandri MT, Lamantia G, Colombo N, Civelli M, Martinelli G, Veglia F, Fiorentini C, Cipolla CM. Prevention of high-dose chemotherapy-induced cardiotoxicity in high-risk patients by angiotensin-converting enzyme inhibition. Circulation. 2006; 114: 2474–2481.LinkGoogle Scholar2 Jensen BV, Nielsen SL, Skovsgaard T. Treatment with angiotensin-converting-enzyme inhibitor for epirubicin-induced dilated cardiomyopathy. Lancet. 1996; 347: 297–299.CrossrefMedlineGoogle Scholar3 Lipshultz E, Lipsitz SR, Sallan SE, Simbre II VC, Shaikh SL, Mone SM, Gelber RD, Colan SD. Long-term enalapril therapy for left ventricular dysfunction in doxorubicin-treated survivors of childhood cancer. J Clin Oncol. 2002; 20: 4517–4522.CrossrefMedlineGoogle Scholar4 Ewer MS, Vooletich MT, Durand JB, Woods ML, Davis JR, Valero V, Lenihan DJ. Reversibility of Trastuzumab-related cardiotoxicity: new insight based on the clinical course and response to treatment. J Clin Oncol. 2005; 23: 7820–7826.CrossrefMedlineGoogle Scholar5 Cardinale D, Sandri MT, Colombo A, Colombo N, Boeri M, Lamantia G, Civelli M, Peccatori F, Martinelli G, Fiorentini C, Cipolla CM. Prognostic value of Troponin I in cardiac risk stratification of cancer patients undergoing high-dose chemotherapy. Circulation. 2004; 109: 2749–2754.LinkGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails June 19, 2007Vol 115, Issue 24 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.107.695619 Originally publishedJune 19, 2007 PDF download Advertisement SubjectsCongenital Heart DiseaseEchocardiography