Ramu Bhavadharini, Masotti Maria, Tedford Ryan J, Cogswell Rebecca J
Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
JACC CardioOncol. 2021 Jun 15;3(2):294-301. doi: 10.1016/j.jaccao.2021.02.010. eCollection 2021 Jun.
Adriamycin-associated cardiomyopathy (ACM) can lead to end-stage heart failure requiring advanced heart failure therapies.
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.
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.
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).
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.
阿霉素相关性心肌病（ACM）可导致终末期心力衰竭，需要先进的心力衰竭治疗方法。
本研究旨在提供当代机械循环支持和心脏移植时代ACM患者心脏移植后的生存数据。
从2008年10月18日至2018年10月18日的器官共享联合网络中识别出接受首次单器官心脏移植的成年人（≥18岁）。纳入了可用左心室辅助装置（LVAD）支持的心肌病亚型，包括ACM、扩张型心肌病（DCM）和缺血性心肌病（ICM）。进行多变量Cox回归分析以确定心肌病亚型与心脏移植后生存之间的关联。
该分析包括18270名患者（ACM患者357名；DCM患者10662名；ICM患者7251名）。ACM心脏移植受者更年轻，女性比例更高，登记时肺血管阻力更高。在研究期间的所有年份中，ACM患者在移植时使用耐用LVAD的比例较低。与DCM患者（调整后风险比：0.96；95%置信区间：0.79至1.40；p = 0.764）或ICM患者（调整后风险比：0.85；95%置信区间：0.6至1.2；p = 0.304）相比，ACM患者心脏移植后的死亡率没有增加。
2008年至2018年间接受心脏移植的ACM患者心脏移植后的生存率与扩张型和缺血性心肌病患者相似。与其他心肌病亚型相比，桥接至移植的LVAD使用率仍然较低。
