Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy.
Cardiology Unit, S. Maria Nuova Hospital, Florence, Italy.
Eur J Heart Fail. 2018 May;20(5):898-906. doi: 10.1002/ejhf.1049. Epub 2017 Nov 16.
Cardiac dysfunction is a severe complication of anthracycline-containing anticancer therapy. The outcome of anthracycline-induced cardiomyopathy (AICM) compared with other non-ischaemic causes of heart failure (HF), such as idiopathic dilated cardiomyopathy (IDCM), is unresolved. The aim of this study was to compare the survival of AICM patients with an IDCM cohort followed at our centre from 1990 to 2016.
We included 67 patients (67% female, 50 ± 15 years) with AICM, defined as onset of otherwise unexplained left ventricular ejection fraction (LVEF) ≤50% following anthracycline therapy, and 488 IDCM patients (28% female, 55 ± 12 years). Patients were followed with constantly optimized HF therapy, for 7.6 ± 5.5 and 8.1 ± 5.5 years, respectively. In both cohorts, 25% of patients reached the combined endpoint of death/heart transplantation. Overall survival rates at 5 and 10 years were similar (AICM: 86% and 61%, IDCM: 88% and 75%; P = 0.61), and so was cardiovascular survival (AICM: 91% and 76%, IDCM: 91% and 80%; P = 0.373), also after 1:1 propensity matching (P = 0.27) and adjusting for age, LVEF and left ventricular size. A trend toward higher all-cause mortality was present in AICM patients [hazard ratio (HR) 1.67, 95% confidence interval (CI) 0.95-2.92, P = 0.076]. No differences were observed between AICM and IDCM with regard to pharmacological HF therapy, but AICM patients were less likely to receive devices (13% vs. 41.8% in IDCM, P < 0.001).
Cardiovascular mortality in patients with AICM did not differ from that of a matched IDCM cohort, despite cancer-related morbidity and less prevalent use of devices. These data suggest that patients with AICM should be treated with appropriate guideline-directed medical therapies similar to other non-ischaemic dilated cardiomyopathies.
心脏功能障碍是含蒽环类抗癌疗法的严重并发症。蒽环类诱导性心肌病（AICM）与其他非缺血性心力衰竭（HF）病因（如特发性扩张型心肌病（IDCM））的结局尚不清楚。本研究旨在比较我们中心在 1990 年至 2016 年期间随访的 AICM 患者与 IDCM 队列的生存率。
我们纳入了 67 名患者（女性占 67%，50±15 岁），这些患者在接受蒽环类药物治疗后出现了无法解释的左心室射血分数（LVEF）≤50%，被定义为 AICM。另外还纳入了 488 名 IDCM 患者（女性占 28%，55±12 岁）。两组患者均接受了不断优化的 HF 治疗，随访时间分别为 7.6±5.5 年和 8.1±5.5 年。在两个队列中，25%的患者达到了死亡/心脏移植的联合终点。AICM 组和 IDCM 组的总体生存率在 5 年和 10 年时相似（AICM：86%和 61%，IDCM：88%和 75%；P=0.61），心血管生存率也相似（AICM：91%和 76%，IDCM：91%和 80%；P=0.373），在进行 1：1 倾向匹配（P=0.27）和校正年龄、LVEF 和左心室大小后也相似。AICM 患者的全因死亡率呈上升趋势[风险比（HR）1.67，95%置信区间（CI）0.95-2.92，P=0.076]。与 IDCM 相比，AICM 和 IDCM 患者在 HF 药物治疗方面没有差异，但 AICM 患者接受器械治疗的可能性较低（AICM 为 13%，IDCM 为 41.8%，P<0.001）。
尽管患有癌症相关疾病且使用器械治疗的可能性较低，但 AICM 患者的心血管死亡率与匹配的 IDCM 队列无差异。这些数据表明，AICM 患者应接受类似其他非缺血性扩张型心肌病的适当指南指导的药物治疗。
