Key result
Chemotherapy-induced cardiomyopathy on MCS is linked to ~19% RVAD use, exceeding ischemic and nonischemic groups.
Why the study?
Patients with anthracycline-induced CCMP and end-stage heart failure are often precluded from transplantation, yet data supporting durable MCS in this population are lacking.
Does durable mechanical circulatory support provide similar survival in patients with chemotherapy-induced cardiomyopathy compared to those with nonischemic or ischemic cardiomyopathy?
Cohort (n=3,812)
Yes
Does durable mechanical circulatory support provide similar survival in patients with chemotherapy-induced cardiomyopathy compared to those with nonischemic or ischemic cardiomyopathy?
Patients with chemotherapy-induced cardiomyopathy undergoing mechanical circulatory support have similar survival to other heart failure etiologies, despite a higher need for right ventricular support and increased bleeding risk.
Supports MCS consideration in chemotherapy-induced cardiomyopathy; leaves open need for prospective confirmation of survival equivalence.
OBJECTIVES: The aim of this study was to investigate the use of durable mechanical circulatory support (MCS) in patients with chemotherapy-induced cardiomyopathy (CCMP) and determine their outcomes and survival in comparison to that of other patients with end-stage heart failure treated similarly. BACKGROUND: Patients with end-stage heart failure as a result of CCMP from anthracyclines are often precluded from heart transplantation because of a history of cancer. In such patients, durable MCS may offer an important chance for life prolongation. Yet, there are no data to support the use of MCS in this increasingly prevalent group of patients. METHODS: We searched 3,812 MCS patients from June 2006 through March 2011 in the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) database for the diagnosis of CCMP. We compared characteristics, outcomes, and survival between CCMP patients and patients with nonischemic cardiomyopathy and ischemic cardiomyopathy. RESULTS: Compared with patients with nonischemic cardiomyopathy and ischemic cardiomyopathy, patients with CCMP were overwhelmingly female (72% vs. 24% vs. 13%, p = 0.001), had MCS more often implanted as destination therapy (33% vs. 14% vs. 22%, p = 0.03), required more right ventricular assist device support (19% vs. 11% vs. 6%, p = 0.006), and had a higher risk of bleeding (p = 0001). Survival of CCMP patients was similar to that of other groups. CONCLUSIONS: CCMP patients treated with MCS have survival similar to other MCS patients despite more frequent need for right ventricular assist device support and increased bleeding risk.
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Oliveira et al. (2013) conducted a cohort in Chemotherapy-induced cardiomyopathy requiring mechanical circulatory support (n=3,812). Chemotherapy-induced cardiomyopathy vs. Nonischemic and ischemic cardiomyopathy was evaluated on Right ventricular assist device support (p=0.006). Chemotherapy-induced cardiomyopathy patients on mechanical circulatory support required more right ventricular assist device support than nonischemic or ischemic groups (19% vs 11% vs 6%, p=0.006).
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