Key result
CRT improves LVEF by ~10 points in chemotherapy-induced cardiomyopathy, matching gains in other non-ischemic cardiomyopathies.
Why the study?
Although cardiac resynchronization therapy (CRT) is often used for chemotherapy-induced cardiomyopathy (CHIC) with LBBB and LVEF 35% or lower, the echocardiographic and clinical outcomes of CRT in this population needed to be determined.
Does cardiac resynchronization therapy improve left ventricular function, reverse remodeling, and affect survival in patients with chemotherapy-induced cardiomyopathy compared to patients with other types of non-ischemic cardiomyopathy?
Cohort (n=87)
Yes
Does cardiac resynchronization therapy improve left ventricular function, reverse remodeling, and affect survival in patients with chemotherapy-induced cardiomyopathy compared to patients with other types of non-ischemic cardiomyopathy?
Patients with chemotherapy-induced cardiomyopathy who meet criteria for CRT experience significant improvements in left ventricular ejection fraction and reverse remodeling comparable to patients with other non-ischemic cardiomyopathies.
BACKGROUND: Several chemotherapy agents are associated with the development of non-ischemic cardiomyopathy (NIC). When chemotherapy-induced cardiomyopathy (CHIC) is associated with left bundle branch block (LBBB) and a left ventricular ejection fraction (LVEF) 35% or lower, cardiac resynchronization therapy (CRT) is often utilized to improve cardiac function and relieve symptoms. OBJECTIVE: To determine the echocardiographic and clinical outcomes of CRT in patients with CHIC. METHODS: The study included 29 patients with CHIC (CHIC group) and 58 patients with other types of NIC (control group) who underwent CRT implantation between 2004 and 2017. The primary endpoints were changes in LVEF, left ventricular end-systolic diameter (LVESD), and left ventricular end-diastolic diameter (LVEDD) at 6-18 months after CRT. The secondary outcomes included changes in left ventricular global longitudinal strain (GLS), systolic strain rate (SRS), early diastolic strain rate (SRE), and overall survival. RESULTS: Out of 29 patients with CHIC, 62.1% received chemotherapy for lymphoma, 13.7% for breast cancer, and 24.1% for sarcoma. The agent implicated in 93.1% of the patients was an anthracycline. Half of the patients had LBBB. The mean baseline LVEF was 28% ± 8%. The mean baseline QRS duration was 146 ± 26 ms. Twenty-eight patients had post-CRT follow-up data. CRT was associated with improvement in echocardiographic outcomes in the CHIC group and the control group. There was no difference in overall survival between the two groups (log-rank p = .148). CONCLUSION: CRT improves left ventricular function and reverses remodeling in patients with CHIC.
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Ezzeddine et al. (2021) conducted a cohort in Chemotherapy-induced cardiomyopathy and other non-ischemic cardiomyopathies undergoing cardiac resynchronization therapy (n=87). Cardiac resynchronization therapy in chemotherapy-induced cardiomyopathy (CHIC) vs. Cardiac resynchronization therapy in other forms of non-ischemic cardiomyopathy (NIC) was evaluated on Mean change in left ventricular ejection fraction (LVEF), LVESD, and LVEDD at 6-18 months after CRT (p=0.985). Cardiac resynchronization therapy significantly increased LVEF in chemotherapy-induced cardiomyopathy from 28% to 38% (p<0.001), with mean LVEF change comparable to other non-ischemic cardiomyopathies (10.2% vs 10.3%, p=0.985).
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