Tie Hongtao, Zhu Jing, Akin Sakir, Allen Larry A, Huang Bi, Martens Sabrina, Welp Henryk, Simpkin Andrew, Shi Rui, Wu Qingchen, Soliman Osama, Caliskan Kadir, Chen Dan
Department of Cardiothoracic Surgery (H.T., Q.W., D.C.), The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Department of Cardiothoracic Surgery, University Hospital Muenster, Germany (H.T., S.M., H.W.).
Circ Heart Fail. 2023 Feb;16(2):e009772. doi: 10.1161/CIRCHEARTFAILURE.122.009772. Epub 2022 Nov 14.
Patients with cancer (patients with a history of cancer) with advanced heart failure are increasing, but unlikely to be transplanted, and left ventricular assist device (LVAD) is an alternative strategy. This study investigates the characteristics and outcomes of patients with cancer undergoing durable LVAD.
Adult patients with a history of cancer who received LVADs were identified from INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) registry: 2008 and 2017. Characteristics and outcomes between patients with cancer and those without cancer were compared, and subgroup analyses of cancer therapy-induced cardiomyopathy (CCM) and non-CCM were also conducted.
Overall, 1273 (6.5%) patients had a history of cancer, including 289 (22.7%) with CCM and 984 (77.3%) with non-CCM as the primary reason for heart failure. Patients with cancer had shorter median survival (3.72 versus 3.97 years, log-rank =0.002), and multivariable Cox and competing risk regressions revealed that a history of cancer was associated with reduced survival (hazard ratio, 1.14 [95% CI, 1.04-1.26]; =0.005; subdistribution hazard ratio, 1.24 [95% CI, 1.13-1.36]; 0.001) and decreased incidence of heart transplantation. There was no significant difference in mortality between patients with CCM-induced heart failure and patients without cancer. Patients with cancer experienced an increased risk of bleeding, and age, INTERMACS profile, albumin, dialysis, and blood urea nitrogen were associated with mortality in these patients.
A history of cancer is associated with mildly reduced survival, lower incidence of heart transplantation, and increased risk of bleeding after LVAD, whereas the survival in patients with cancer with CCM-induced heart failure is similar to those without cancer. LVAD implantation in patients with cancer is very well possible.
患有晚期心力衰竭的癌症患者（有癌症病史的患者）数量正在增加，但不太可能接受心脏移植，而左心室辅助装置（LVAD）是一种替代策略。本研究调查了接受耐用LVAD的癌症患者的特征和结局。
从2008年至2017年的INTERMACS（机械辅助循环支持机构间注册中心）注册库中识别出有癌症病史且接受LVAD的成年患者。比较了癌症患者和非癌症患者的特征及结局，并对癌症治疗引起的心肌病（CCM）和非CCM进行了亚组分析。
总体而言，1273例（6.5%）患者有癌症病史，其中289例（22.7%）以CCM为心力衰竭的主要原因，984例（77.3%）以非CCM为主要原因。癌症患者的中位生存期较短（3.72年对3.97年，对数秩检验=0.002），多变量Cox回归和竞争风险回归显示，癌症病史与生存率降低相关（风险比，1.14[95%CI，1.04 - 1.26]；P = 0.005；亚分布风险比，1.24[95%CI，1.13 - 1.36]；P = 0.001），且心脏移植发生率降低。CCM引起的心力衰竭患者与非癌症患者的死亡率无显著差异。癌症患者出血风险增加，年龄、INTERMACS分级、白蛋白、透析和血尿素氮与这些患者的死亡率相关。
癌症病史与LVAD植入术后生存率轻度降低、心脏移植发生率降低及出血风险增加相关，而CCM引起心力衰竭的癌症患者的生存率与非癌症患者相似。癌症患者植入LVAD是完全可行的。
