Risk factors for early antracycline-induced cardiomyopathy

Introduction: Anthracycline-induced cardiomyopathy (AIC) is defined as “early” (eAIC) when it occurs in the first year after the introduction of anthracyclines therapy. The benefit of treatment can be reduced by the AIC emergence, influencing the prognosis of patients with cancer both by a high rate of heart failure and death reported after 2 years in 50% of patients, and worsening of cancer evolution due to interruption of antraciclines. In this context the prevention of AIC, by identifying the risk factors and early diagnosis of heart dysfunction are important goals in clinical practice. Purpose: The study evaluated the risk factors for developing of asymptomatic eAIC. Methods: 68 patients with cancer treated with anthracyclines were supervised 6 months for the occurrence of eAIC, diagnosed by the reduction of left ventricular ejection fraction <50% (2D transthoracic echocardiography, modifi ed biplane Simpson method) or by >10%, compared to baseline (ACC/AHA/ASE Committee 2003). Baseline demographic characteristics [age, sex, body mass index (BMI)], cardiovascular risk factors (smoking, hypertension, diabetes, dyslipidemia) and inducible myocardial ischemia in exercise test (ET) on treadmill, Bruce protocol (horizontal or downsloping segment depression of ST ≥1 mm occurred in at least two contingent derivatives) were studied in relation with the occurrence eAIC. Statistics: GraphPad InStat 3, p < 0.05. Results: After 6 months 15 patients (pts) (22.05%) (Gr 1) were diagnosed with asymptomatic eAIC and 53 pts (77.95%) evolved without eAIC (Gr 2). There were statistically significant differences in the average age, which was higher in pts of Gr 1 compared with those in Gr 2 (62.5 ± 7.2 years vs 54.9 ± 10.4 years, p = 0.009). The presence of cardiovascular risk factors and their association did not influence the occurrence of eAIC in pts treated with anthracyclines. Baseline evaluation of inducible myocardial ischemia using ECG ET revealed the presence of ischemic heart disease in a signifi cantly higher number of pts in Gr1 vs Gr2 [6 pts (40%) vs 6 pts (11%), p = 0.0186]. Conclusions: Early anthracycline-induced cardiomyopathy is favored by the age over 60 and pre-existing ischemic heart disease. These data underline that the patients at risk for developing AIC, require supervision from specialists in cardiology and oncology according to specific protocols.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)