Clinical Investigation
Cancer Therapy-Induced Left Ventricular Dysfunction: Interventions and Prognosis

https://doi.org/10.1016/j.cardfail.2013.12.018Get rights and content

Abstract

Background

For multiple chemotherapeutics, cardiotoxicity is dose limiting and can lead to substantial morbidity and mortality. Early cardiac intervention has the potential to positively affect clinical course.

Methods and Results

We reviewed 247 consecutive patients referred to the Stanford cardiology clinic for cancer therapy-associated cardiac abnormalities from 2004 to 2012. A comprehensive review of records was performed, with documentation of baseline characteristics, cardiac imaging, medications, and clinical course. Seventy-nine patients who had left ventricular ejection fraction (LVEF) declines temporally associated with cancer therapy were included. The most common malignancies were breast (46%) and hematologic (35%); 71% of the patients were female, and overall mean age was 52 years. The primary cancer therapeutics associated with LVEF decline included anthracyclines, trastuzumab, and tyrosine kinase inhibitors. The mean LVEF was 60% before cancer therapy and 40% after cancer therapy. The most common cardiac interventions included beta-blockers (84%) and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (83%). Mean LVEF after cardiac intervention rose to 53%; 77% of patients had LVEF recovery to ≥50%, and 68% of these patients had recovery within 6 months of starting cardiac therapy; 76% of patients were able to continue their planned cancer therapy.

Conclusions

With appropriate cardiac intervention, the majority of patients with LVEF decline from cancer therapy can achieve LVEF recovery and complete their cancer therapy.

Section snippets

Methods

After Institutional Review Board approval, a comprehensive review was performed of all consecutive patients referred to the Stanford Cardiology clinic for treatment of cancer therapy-associated cardiac disease from August 2004 to July 2012. The primary inclusion criterion was referral to the cardiology clinic for the presence of any decline in LVEF to below normal, temporally associated with cancer therapy. In our laboratory, LVEF <55% is considered to be abnormal. Although we included all of

Results

Of 247 consecutive patients screened, 79 patients met the inclusion criteria. Baseline characteristics are included in Table 1. Although 10 malignancies were represented, the majority of the patients had either breast cancer (46%) or hematologic malignancies (35%). Most patients did not have significant cardiac comorbidities or preexisting use of cardiac medications.

The group underwent both medical (medications) and device (cardiac resynchronization therapy for left bundle branch block [LBBB])

Discussion

Advances in cancer therapeutics have led to the development of more effective chemotherapy agents, providing treatment options for even many aggressive cancers. Little literature exists to guide clinicians on the natural history of LVEF recovery following cancer therapies, particularly with newer targeted cancer therapies and with the use of cardiac medications. Among a cohort of patients who experienced a decline in LVEF, we aimed to describe how many were able to recover their cardiac

Disclosures

None.

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