May 7, 2015Circulation
Early Detection of Anthracycline Cardiotoxicity and Improvement With Heart Failure Therapy
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Key result
Early HF therapy achieves ~71% partial recovery in patients with anthracycline-induced cardiotoxicity.
Why the study?
Does early detection and prompt heart failure therapy improve left ventricular ejection fraction recovery in patients developing anthracycline-induced cardiotoxicity?
Population
2,625 chemotherapy-naive adults scheduled for anthracycline-containing therapy for various tumors at first…
Design
Cohort
Follow-up
median 5.2 years
Authors
Discussion
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Implication
Early HF therapy after detection may aid recovery; extends observational data but leaves open causal benefit in trials.
Structured PICO
Does early detection and prompt heart failure therapy improve left ventricular ejection fraction recovery in patients developing anthracycline-induced cardiotoxicity?
P
Population
2,625 chemotherapy-naive adults scheduled for anthracycline-containing therapy for various tumors at first diagnosis (51% breast cancer, 28% non-Hodgkin lymphoma), mean age 50, 74% female. Exclusions: <18 years of age, LVEF <50%, valvular heart disease, severe hypertension, life expectancy ≤12 weeks, high-dose protocol, and anthracycline therapy followed by trastuzumab.
I
Intervention
Echocardiographic monitoring for early detection of cardiotoxicity, followed by prompt initiation of heart failure therapy (enalapril alone or enalapril plus beta-blockers like carvedilol or bisoprolol) up-titrated to the maximal tolerated dose.
O
Outcome
Time of occurrence of cardiotoxicity (defined as a reduction in LVEF >10 percentage points from baseline and <50%)surrogate
Most anthracycline-induced cardiotoxicity occurs within the first year of treatment, and early detection with prompt initiation of heart failure therapy is associated with substantial recovery of cardiac function.
Limitations
- Cannot exclude spontaneous LVEF recovery because heart failure therapy was started promptly after detection
- Association between asymptomatic LVEF decline and later development of symptomatic heart failure remains speculative
Cite This Study
Cardinale et al. (2015) studied this question. Anthracycline-induced cardiotoxicity occurred in 9% of patients, with 71% experiencing partial recovery after heart failure therapy initiated early post-chemotherapy.
Topics
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