Outcomes of cardiac resynchronization therapy in patients with chemotherapy‐induced cardiomyopathy

Abstract

Background Several chemotherapy agents are associated with the development of non‐ischemic cardiomyopathy (NIC). When chemotherapy‐induced cardiomyopathy (CHIC) is associated with left bundle branch block (LBBB) and a left ventricular ejection fraction (LVEF) 35% or lower, cardiac resynchronization therapy (CRT) is often utilized to improve cardiac function and relieve symptoms. Objective To determine the echocardiographic and clinical outcomes of CRT in patients with CHIC. Methods The study included 29 patients with CHIC (CHIC group) and 58 patients with other types of NIC (control group) who underwent CRT implantation between 2004 and 2017. The primary endpoints were changes in LVEF, left ventricular end‐systolic diameter (LVESD), and left ventricular end‐diastolic diameter (LVEDD) at 6–18 months after CRT. The secondary outcomes included changes in left ventricular global longitudinal strain (GLS), systolic strain rate (SRS), early diastolic strain rate (SRE), and overall survival. Results Out of 29 patients with CHIC, 62.1% received chemotherapy for lymphoma, 13.7% for breast cancer, and 24.1% for sarcoma. The agent implicated in 93.1% of the patients was an anthracycline. Half of the patients had LBBB. The mean baseline LVEF was 28% ± 8%. The mean baseline QRS duration was 146 ± 26 ms. Twenty‐eight patients had post‐CRT follow‐up data. CRT was associated with improvement in echocardiographic outcomes in the CHIC group and the control group. There was no difference in overall survival between the two groups (log‐rank p = .148). Conclusion CRT improves left ventricular function and reverses remodeling in patients with CHIC.

Management of Advanced Heart Failure in Children with Cancer Therapy-Related Cardiac Dysfunction

“…The experience with CRT has largely been limited to adult cancer survivors. A retrospective study at the Mayo Clinic, including 29 patients with CTRCD who underwent CRT showed improvement in echo parameters within six to 18 months including increased LV EF and decreased LV diastolic and systolic dimensions [44]. Similar findings were seen in the MADIT-CHIC (Multicenter Automatic Defibrillator Implantation Trial-Chemotherapy-Induced Cardiomyopathy) study, an un-controlled prospective cohort study.…”

Statin Use Can Attenuate the Decline in Left Ventricular Ejection Fraction and the Incidence of Cardiomyopathy in Cardiotoxic Chemotherapy Recipients: A Systematic Review and Meta-Analysis

“…Although cardiac dysfunction related to chemotherapy could be addressed with an interruption or discontinuation of chemotherapy, the cessation of chemotherapy in cancer patients may be related to poor clinical outcomes from the oncology standpoint. Furthermore, 0.5-2.5% of patients with chemotherapy-induced cardiomyopathy may have end-stage heart failure requiring a left-ventricular assist device or even heart transplant [9,10,[33][34][35]. Due to the possible poor trajectory, guidelines for prevention and surveillance of chemotherapy-induced cardiomyopathy are imperative.…”

Efficacy and safety of cardiac resynchronization therapy in chemotherapy‐induced cardiomyopathy: A systematic review

“…Singh et al (2019) reported improvement of LVEF from 28.5 ± 3.8% to 39.1 ± 7.1%, LVESV from 122.7 mL to 89 mL, LVEDV from 171 to 143.2 mL, and an improvement in NYHA class after CRT implantation. Ezzeddine et al (2021) and Patel et al (2022) demonstrated improved LVEF from 28 ± 8% to 38 ± 10% and 21.7 ± 7.4% to 30.4 ± 13.0%, respectively (Table 2).…”

“…Chemotherapy is a crucial treatment option for various types of cancer, however, its use is associated with several adverse effects, one of which is chemotherapy‐induced cardiomyopathy (CIC) (Ezzeddine et al, 2021 ; Fadol et al, 2017 ; Patel et al, 2022 ; Rickard et al, 2010 ; Singh et al, 2019 ). CIC is characterized by a decline in left ventricular function, leading to symptoms of heart failure (Rickard et al, 2010 ).…”

“…Cardiac resynchronization therapy (CRT) is a widely used treatment for heart failure in a wide range of etiologies (Singh et al, 2019 ). It involves the placement of a biventricular pacemaker that resynchronizes the electrical activity of the ventricles, leading to improved cardiac function (Ezzeddine et al, 2021 ). Despite the widespread use of CRT, there is limited information on its efficacy and safety in patients with CIC.…”