Anthracycline Treatment and Ventricular Remodeling in Left Ventricular Assist Device Patients

Abstract

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.

Recovery from anthracycline-induced cardiomyopathy with biventricular assist and valve repairs: A case report and literature review

“…Table 1 summarizes the previously reported cases of successful weaning from VAD in patients with anthracycline-induced cardiomyopathy. [7][8][9][10][11][12][13] Our patient showed some differences from those of the previous reports. First, the cumulative dose of anthracycline in our patient was relatively lower than that of the previous reports.…”

“…Table 1 summarizes the previously reported cases of successful weaning from VAD in patients with anthracycline-induced cardiomyopathy. 7–13…”

Use of integrated imaging and serum biomarker profiles to identify subclinical dysfunction in pediatric cancer patients treated with anthracyclines

“…Structural changes at the time of LV assist device implantation in heart failure patients who had been exposed to AC, have demonstrated varying degrees of adverse cardiac remodeling with moderate-to-severe myocyte hypertrophy, moderate myocytolysis, and perivascular and interstitial fibrosis with areas of replacement fibrosis [ 66 ]. Prolonged hypertrophy and fibrosis in response to pathological signals is associated with an increase in morbidity and mortality as a result of impaired left ventricular relaxation and systolic dysfunction with development of heart failure.…”

Heart Failure Therapies for End-Stage Chemotherapy–Induced Cardiomyopathy

“…In a recent study of a small number of patients receiving LVAD therapy with a history of anthracycline exposure, no significant correlation was found between the severity of histopathologic changes and the onset or duration of HF symptoms, however, there was a trend toward more severe histopathologic changes (more extensive fibrosis) in patients who continued to require LVAD support than in patients whose LVAD was explanted owing to recovery. 65 Whether recovery can be assessed histopathologically remains unknown.…”