Thomas Garry R, McDonald Michael A, Day Jennifer, Ross Heather J, Delgado Diego H, Billia Filio, Butany Jagdish W, Rao Vivek, Amir Eitan, Bedard Philippe L, Thavendiranathan Paaladinesh
Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Center, University Health Network, University of Toronto, Toronto, Ontario, Canada; Ted Rogers Center of Excellence in Heart Function, Peter Munk Cardiac Center, University Health Network, University of Toronto, Toronto, Ontario, Canada.
Am J Cardiol. 2016 Nov 15;118(10):1539-1544. doi: 10.1016/j.amjcard.2016.08.020. Epub 2016 Aug 23.
Anthracycline-induced cardiomyopathy (AIC) may progress to end-stage heart failure requiring mechanical circulatory support or orthotopic heart transplantation (OHT). Previous studies have described important clinical differences between AIC and nonischemic cardiomyopathy (NIC) cohorts requiring these advanced interventions. Therefore, we sought to extend this literature by comparing echocardiographic parameters, treatment strategies, and the prognosis between matched patients from these cohorts. This is a retrospective matched cohort study. All patients who received a ventricular assist device or OHT at a large Canadian center were reviewed (n = 421; 1988 to 2015) and subjects with clinical and pathologic evidence of AIC were included (n = 17, 4.0%). A comparison cohort with idiopathic NIC from the same database, matched 3:1 for age, gender, ethnicity, and year of heart failure onset was selected. The Mann-Whitney rank-sum and Fisher's exact tests were used for comparisons. Patients with AIC were predominantly women (70.6%) with heart failure diagnosed at age 40.2 ± 15.8 and 8.3 ± 8.9 years after anthracycline treatment. Compared with NIC, no differences were seen in co-morbidities, echocardiographic measures, the proportion of patients receiving a defibrillator, ventricular assist device, or OHT, the incidence of graft failure, and all-cause mortality. In contrast to other studies, AIC was not associated with a higher incidence of right ventricular dysfunction. A greater proportion of patients with AIC developed cancer (recurrence or new primary) post-OHT (21.4% vs 2.3%, p = 0.042). In conclusion, we demonstrate that when matched cohorts of patients with end-stage heart failure secondary to AIC and idiopathic NIC are compared, they are similar with respect to co-morbidities, degree of ventricular dysfunction, and advanced therapeutics used. The prognosis with OHT is also similar.
蒽环类药物诱导的心肌病（AIC）可能进展为终末期心力衰竭，需要机械循环支持或原位心脏移植（OHT）。先前的研究描述了需要这些高级干预措施的AIC队列与非缺血性心肌病（NIC）队列之间重要的临床差异。因此，我们试图通过比较这些队列中匹配患者的超声心动图参数、治疗策略和预后，来扩展这方面的文献。这是一项回顾性匹配队列研究。对在加拿大一个大型中心接受心室辅助装置或OHT的所有患者进行了回顾（n = 421；1988年至2015年），纳入了有AIC临床和病理证据的受试者（n = 17，4.0%）。从同一数据库中选择了特发性NIC的比较队列，在年龄、性别、种族和心力衰竭发病年份方面按3:1进行匹配。采用曼-惠特尼秩和检验与费舍尔精确检验进行比较。AIC患者以女性为主（70.6%），心力衰竭诊断年龄为40.2±15.8岁，蒽环类药物治疗后8.3±8.9年。与NIC相比，在合并症、超声心动图测量、接受除颤器、心室辅助装置或OHT的患者比例、移植失败发生率和全因死亡率方面未发现差异。与其他研究不同，AIC与右心室功能障碍的较高发生率无关。AIC患者中更大比例在OHT后发生癌症（复发或新发原发性癌症）（21.4%对2.3%，p = 0.042）。总之，我们证明，当比较继发于AIC和特发性NIC的终末期心力衰竭患者的匹配队列时，他们在合并症、心室功能障碍程度和所使用的高级治疗方法方面相似。OHT的预后也相似。
