Anthracycline Cardiotoxicity in Adults | Journal Scan

May 13, 2015
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Authors:
Cardinale D, Colombo A, Bacchiani G, et al.
Citation:
Early Detection of Anthracycline Cardiotoxicity and Improvement With Heart Failure Therapy. Circulation 2015;May 6:[Epub ahead of print].
Summary By:
Debabrata Mukherjee, MD, FACC

Study Questions:

What is the incidence, time of occurrence, clinical correlates, and response to heart failure (HF) therapy of anthracycline-induced cardiotoxicity?

Methods:

The investigators assessed left ventricular ejection fraction (LVEF), at baseline, every 3 months during chemotherapy and for the following year, every 6 months over the following 4 years, and yearly afterwards in a heterogeneous cohort of 2,625 patients receiving anthracycline-containing therapy. In case of cardiotoxicity (LVEF decrease >10% units, and below 50%), HF therapy was initiated. Recovery from cardiotoxicity was defined as partial (LVEF increase >5% units and above 50%) or full (LVEF increase to the baseline value). The median follow-up was 5.2 (Q1-Q3 2.6–8.0) years.

Results:

The overall incidence of cardiotoxicity was 9% (n = 226). The median time elapsed between end of chemotherapy and cardiotoxicity development was 3.5 (Q1-Q3 3-6) months. In 98% of cases (n = 221), cardiotoxicity occurred within the first year. Twenty-five (11%) patients had full and 160 (71%) patients had partial recovery. At multivariable analysis, end-chemotherapy LVEF (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.33-1.42 for each percent unit decrement) and cumulative doxorubicin dose (HR, 1.09; 95% CI, 1.04-1.15 for each 50 mg/mq increment) were independent correlates of cardiotoxicity.

Conclusions:

The authors concluded that most cardiotoxicity occurs within the first year and is associated with anthracycline dose and LVEF at the end of treatment.

Perspective:

This study reports that anthracycline-induced cardiotoxicity occurred in 9% of adult treated patients, was dose-dependent, and its highest incidence was observed during the first year after the completion of chemotherapy. Furthermore, close monitoring of cardiac function during this period allowed early detection and prompt treatment of cardiotoxicity, with major LVEF improvement in most cases. Patients should be closely monitored for LV function during the first year after anthracycline chemotherapy.

Keywords: Anthracyclines, Antibiotics, Antineoplastic, Cardiomyopathies, Cardiotoxins, Chemotherapy, Cancer, Regional Perfusion, Doxorubicin, Early Diagnosis, Follow-Up Studies, Heart Failure, Incidence, Stroke Volume, Ventricular Function, Left


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