Valzania Cinzia, Calvi Valeria, Schirripa Valentina, Esposito Francesca, Donnici Giovanni, Borrello Francesco, Arestia Alberto, Sassone Biagio
Department of Cardiology, IRCCS - Azienda Ospedaliero, Universitaria Di Bologna - Policlinico Di S. Orsola, Bologna, Italy.
Policlinico G. Rodolico - San Marco, Azienda Ospedaliera Universitaria, Catania, Italy.
Heart Fail Rev. 2025 Sep 4. doi: 10.1007/s10741-025-10554-7.
Chemotherapy-induced cardiomyopathy (CHIC) represents a growing clinical challenge due to the increasing use of cardiotoxic treatments. These therapies can lead to progressive myocardial dysfunction, ultimately resulting in heart failure. Cardiac resynchronization therapy (CRT) has been widely investigated in selected patients with chronic heart failure; however, those with CHIC remain underrepresented in CRT trials. Current evidence is largely based on retrospective and observational studies, with MADIT-CHIC being the only prospective trial to date. No randomized controlled trials are currently available. Despite encouraging findings, existing data remain limited by small sample sizes and short follow-up durations. In particular, the impact of CRT on left ventricular dyssynchrony, arrhythmic burden, and long-term survival in this population has not been fully elucidated. A multidisciplinary cardio-oncology approach is essential not only for the comprehensive management of these complex patients, but also to guide appropriate timing of CRT implantation. Further research is warranted to refine patient selection criteria and to fully assess the long-term benefits and risks of CRT in patients with CHIC.
由于心脏毒性治疗的使用增加，化疗引起的心肌病（CHIC）成为日益严峻的临床挑战。这些疗法可导致进行性心肌功能障碍，最终导致心力衰竭。心脏再同步治疗（CRT）已在选定的慢性心力衰竭患者中进行了广泛研究；然而，CHIC患者在CRT试验中的代表性仍然不足。目前的证据主要基于回顾性和观察性研究，MADIT-CHIC是迄今为止唯一的前瞻性试验。目前尚无随机对照试验。尽管有令人鼓舞的发现，但现有数据仍受样本量小和随访时间短的限制。特别是，CRT对该人群左心室不同步、心律失常负担和长期生存的影响尚未完全阐明。多学科心脏肿瘤学方法不仅对于这些复杂患者的综合管理至关重要，而且对于指导CRT植入的合适时机也至关重要。有必要进行进一步研究以完善患者选择标准，并全面评估CRT在CHIC患者中的长期益处和风险。
