Subject(s)
Humans , Echocardiography/methods , Ventricular Dysfunction, Left/diagnostic imaging , Early Detection of Cancer , Heart Ventricles/diagnostic imaging , Neoplasms/drug therapy , Antineoplastic Agents/adverse effects , Radionuclide Ventriculography , Ventricular Function, Left , Ventricular Dysfunction, Left/physiopathology , Cardiotoxicity/diagnostic imaging , Medical Oncology/methods , Medical Oncology/standards , Neoplasms/physiopathologyABSTRACT
Nonischemic cardiomyopathy can complicate antineoplastic therapy and lead to irreversible heart failure. We evaluated structural changes at the time of left ventricular assist device implantation in heart failure patients who had been exposed to anthracycline, and we correlated those changes with clinical presentation. We retrospectively studied left ventricular core samples taken at implantation of the HeartMate II left ventricular assist device in 12 heart failure patients (mean age, 46 ± 16 yr) who had histories of anthracycline exposure. We evaluated those samples for hypertrophy, myocytolysis, and fibrosis. Histopathologic findings showed moderate-to-severe myocyte hypertrophy, moderate myocytolysis, and perivascular and interstitial fibrosis with areas of replacement fibrosis. Ultrastructural studies revealed marked decreases in myofibrils, diffuse mitochondrial swelling, and disorganization of the sarcoplasmic reticulum. The interval between anthracycline therapy and heart failure was a mean of 6.8 ± 5.7 years; duration of heart failure symptoms, 38 ± 47 months; and duration of device support, 414 ± 266 days. Four patients are continuing on device support, 3 have undergone transplantation, 3 have undergone device explantation, and 2 have died. The time of heart failure onset and the duration of symptoms did not correlate with the severity and extent of the histopathologic changes. The histopathologic findings and the clinical course varied in heart failure patients with anthracycline exposure. No correlation was observed between anthracycline therapy and the development or duration of heart failure symptoms, severity of histopathologic changes, or outcomes.
Subject(s)
Anthracyclines/therapeutic use , Cardiomyopathies/chemically induced , Heart Failure/therapy , Heart-Assist Devices , Adult , Anthracyclines/adverse effects , Antineoplastic Agents/adverse effects , Female , Humans , Male , Middle Aged , Remission Induction , Retrospective Studies , Ventricular RemodelingABSTRACT
We report the case of a patient who had chronic anthracycline-induced cardiomyopathy that was reversed after treatment with a left ventricular assist device. A 29-year-old woman had undergone anthracycline-based chemotherapy as a teenager in 1991 and 1992 and received a diagnosis of dilated cardiomyopathy 10 years later. Optimal medical therapy had initially controlled the symptoms of heart failure. However, in June 2006, the symptoms worsened to New York Heart Association functional class IV status. We implanted a continuous-flow left ventricular assist device as a bridge to cardiac transplantation; of note, a left ventricular core biopsy at that time showed no replacement fibrosis. The patient's clinical status improved thereafter, enabling left ventricular assist device ex-plantation after 17 months. To our knowledge, this is the first report of the use of left ventricular assist device support to reverse chronic anthracycline-induced heart failure.
Subject(s)
Anthracyclines/adverse effects , Antineoplastic Agents/adverse effects , Cardiomyopathy, Dilated/therapy , Heart Failure/therapy , Heart-Assist Devices , Adult , Biopsy , Cardiomyopathy, Dilated/chemically induced , Cardiomyopathy, Dilated/diagnosis , Cardiomyopathy, Dilated/physiopathology , Chronic Disease , Device Removal , Female , Heart Failure/chemically induced , Heart Failure/diagnosis , Heart Failure/physiopathology , Heart Ventricles/drug effects , Heart Ventricles/physiopathology , Heart Ventricles/ultrastructure , Hodgkin Disease/drug therapy , Humans , Microscopy, Electron , Prosthesis Design , Remission Induction , Time Factors , Treatment Outcome , Ventricular Function, LeftABSTRACT
The number of cancer survivors in the United States has exceeded 12 million and is increasing. After secondary malignancies, cardiovascular disease is the leading cause of late morbidity and death among cancer survivors. The cardiovascular needs of cancer survivors have not been described. We describe the clinical characteristics of 53 patients seen during the first year of our Cardiovascular Prevention in Cancer Survivors clinic. The mean age of the patients was 40.1 ± 13.7 years. The mean survival since cancer diagnosis was 13.9 years. A history of chemotherapy-induced cardiomyopathy was present in 21%, and 5.7% had known atherosclerotic disease. One fourth had hypertension; 32.1%, dyslipidemia; and 13%, diabetes mellitus. Three quarters had received anthracycline chemotherapy, while half had received radiation. Half had an abnormal echocardiogram (55%), and 11 of 18 had an abnormal carotid ultrasonogram. The mean Framingham risk score for patients older than 30 years (n=37) was 8.4, yielding a 10-year risk of cardiovascular disease of 7.6%. The mean vascular age was 54.3 years, and the mean chronological age was 46.3 years. The mean follow-up duration was 566 ± 213 days. There were significant improvements in serum triglycerides and high-density lipoprotein levels, as well as trends toward improved blood pressure control. Cardiovascular risk factors are prevalent in cancer survivors. There is an immediate need for the widespread availability of cardiovascular preventive services to reduce the late adverse effects of chemotherapy and radiation. Early intervention might help to improve the cardiovascular risk profile.
