Although a majority of patients with anthracycline-induced heart failure experience clinical recovery, their limited cardiac reserve leaves them highly vulnerable to fatal relapses during subsequent physiological stress.
Recovery from anthracycline cardiomyopathy warrants caution during stress; leaves open optimal surveillance strategies in cancer survivors.
BACKGROUND: Anthracycline-induced congestive heart failure (A-CHF) is associated with a high reported incidence of morbidity and mortality. The long-term clinical outcome of patients with clinical A-CHF is less well defined. METHODS: A retrospective chart review was done of 19 patients with a clinical diagnosis of A-CHF. RESULTS: In 19 patients, the mean anthracycline dose was 379 +/- 141 mg/m2 (range, 120-570 mg/m2). The median time from the last dose of the drug to the onset of A-CHF was 4 weeks (range, 1-17 weeks). Seven patients (Group I) died of A-CHF within a median of 6 weeks (range, 1-15 weeks) from onset of disease to death. Twelve patients (Group II) had clinical recovery, three with a complete response, eight had partial improvement, and one had stable disease. Most importantly, four patients who had an intercurrent illness (two patients with infections and two with progression of their malignant lesions) had a relapse of clinical congestive heart failure that was fatal. CONCLUSIONS: Many (63%) patients recover from clinical A-CHF. However, the cardiac reserve of these patients is limited, and they may require careful medical management during other illnesses or surgical procedures.
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Moreb et al. (1992) studied this question.
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