Key result
Adriamycin-associated cardiomyopathy was not associated with an increase in post-cardiac transplant mortality compared to dilated cardiomyopathy (HR 0.96; 95% CI 0.79-1.40; p=0.764).
Why the study?
Adriamycin-associated cardiomyopathy can lead to end-stage heart failure, but post-cardiac transplant survival data in the contemporary era of mechanical circulatory support and cardiac transplantation were needed.
Does Adriamycin-associated cardiomyopathy affect post-cardiac transplant survival compared to dilated or ischemic cardiomyopathy in adult heart transplant recipients?
Cohort (n=18,270)
Yes
Does Adriamycin-associated cardiomyopathy affect post-cardiac transplant survival compared to dilated or ischemic cardiomyopathy in adult heart transplant recipients?
Hazard Ratio: 0.96 (95% CI 0.79–1.4)
p-value: p=0.764
Patients with Adriamycin-associated cardiomyopathy have similar post-heart transplant survival compared to those with dilated or ischemic cardiomyopathy, despite lower rates of bridge-to-transplant LVAD use.
May expand transplant eligibility for adriamycin cardiomyopathy; leaves open prospective validation.
BACKGROUND: Adriamycin-associated cardiomyopathy (ACM) can lead to end-stage heart failure requiring advanced heart failure therapies. OBJECTIVES: This study sought to provide post-cardiac transplant survival data in patients with ACM in the contemporary era of mechanical circulatory support and cardiac transplantation. METHODS: Adults (≥18 years of age) who underwent first-time, single-organ heart transplantation were identified from the United Network for Organ Sharing between October 18, 2008, and October 18, 2018. Cardiomyopathy subtypes that could have been supported with a left ventricular assist device (LVAD) including ACM, dilated cardiomyopathy (DCM), and ischemic cardiomyopathy (ICM) were included. A multivariable Cox regression analysis was performed to determine the association between cardiomyopathy subtype and post-cardiac transplant survival. RESULTS: This analysis included 18,270 patients (357 with ACM; 10,662 with DCM; and 7,251 with ICM). Heart transplant recipients with ACM were younger, included more women, and had higher pulmonary vascular resistance at the time of listing. Patients with ACM had a lower percentage of durable LVADs at the time of transplant across all years of the study period. Patients with ACM did not experience an increase in post-cardiac transplant mortality compared to those with DCM (adjusted hazard ratio: 0.96; 95% confidence interval: 0.79 to 1.40; p = 0.764) or ICM (adjusted hazard ratio: 0.85; 95% confidence interval: 0.6 to 1.2; p = 0.304). CONCLUSIONS: Patients with ACM who received heart transplants between 2008 and 2018 had similar post-cardiac transplant survival to those with dilated and ischemic cardiomyopathy. Bridge-to-transplant LVAD use remains lower compared to other cardiomyopathy subtypes.
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Ramu et al. (2021) conducted a cohort in Adriamycin-associated cardiomyopathy (n=18,270). Adriamycin-associated cardiomyopathy (ACM) vs. Dilated cardiomyopathy (DCM) and ischemic cardiomyopathy (ICM) was evaluated on post-cardiac transplant mortality (HR 0.96, 95% CI 0.79-1.40, p=0.764). Adriamycin-associated cardiomyopathy was not associated with an increase in post-cardiac transplant mortality compared to dilated cardiomyopathy (HR 0.96; 95% CI 0.79-1.40; p=0.764).
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