Key result
Add-on vericiguat and ivabradine restores LVEF to ~52% in an anthracycline-induced cardiomyopathy case.
Why the study?
Cardiovascular complications developing more than 10 years after anthracycline chemotherapy carry a poor prognosis, prompting reporting on the efficacy of a multidrug regimen based on quadruple therapy for worsening heart failure in these cancer survivors.
Does multidrug treatment with add-on vericiguat and ivabradine based on quadruple therapy improve symptoms and cardiac remodeling in young adult cancer survivors with severe anthracycline-induced cardiomyopathy?
Case Report (n=1)
No
Does multidrug treatment with add-on vericiguat and ivabradine based on quadruple therapy improve symptoms and cardiac remodeling in young adult cancer survivors with severe anthracycline-induced cardiomyopathy?
Multidrug treatment with add-on vericiguat and ivabradine to quadruple therapy can potentially treat worsening heart failure in young adult cancer survivors with severe anthracycline-induced cardiomyopathy.
May support add-on vericiguat-ivabradine in refractory anthracycline cardiomyopathy; hypothesis-generating and requires prospective trials.
BACKGROUND: The overall mortality and morbidity benefit in patients with heart failure with a reduced ejection fraction is greatest with a treatment combination of sacubitril/valsartan, beta-blockers, mineralocorticoid-receptor antagonists, and sodium-glucose transporter-2 inhibitors, termed the "fantastic four" or "quadruple therapy." The addition of vericiguat (an oral soluble guanylate cyclase stimulator) is believed to aid in managing worsening heart failure after quadruple therapy. Among childhood and young adult cancer survivors, cardiovascular complications that develop more than 10 years after anthracycline-based chemotherapy have a poor prognosis. Therefore, this study reports the efficacy of multidrug regimen based on quadruple therapy for worsening heart failure in cancer survivors with anthracycline-induced cardiomyopathy. CASE PRESENTATION: A survivor of cancer as a young adult who received high-dose anthracycline chemotherapy presented with acute decompensated heart failure 20 years post-chemotherapy and worsening heart failure 1.5 years after discharge. The patient showed signs of improvement after a step-wise introduction of carvedilol, empagliflozin, sacubitril/valsartan, ivabradine, and spironolactone for worsening heart failure. Vericiguat was accelerated owing to the risk of more severe cardiovascular events associated with ongoing aortic stenosis and the poor prognosis of anthracycline-induced cardiomyopathy. Heart failure symptoms continued to improve, with significant cardiac reverse remodeling, and the patient successfully underwent aortic valve replacement for severe aortic stenosis. CONCLUSIONS: Our case highlighted that multidrug treatment with add-on vericiguat and ivabradine based on quadruple therapy can potentially treat worsening heart failure in young adult cancer survivors with severe anthracycline-induced cardiomyopathy.
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Oda et al. (2024) conducted a case report in Worsening heart failure caused by anthracycline-induced cardiomyopathy (n=1). Quadruple therapy with add-on vericiguat and ivabradine was evaluated on Clinical improvement and cardiac reverse remodeling. Multidrug treatment with add-on vericiguat and ivabradine based on quadruple therapy improved heart failure symptoms and increased left ventricular ejection fraction from 18% to 52% in a patient with anthracycline-induced cardiomyopathy.
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