Comparison of long‐term outcome in anthracycline‐related versus idiopathic dilated cardiomyopathy: a single centre experience

• Published in: European journal of heart failure 2018-05, Vol.20 (5), p.898-906
• Main Authors: Fornaro, Alessandra, Olivotto, Iacopo, Rigacci, Luigi, Ciaccheri, Mauro, Tomberli, Benedetta, Ferrantini, Cecilia, Coppini, Raffaele, Girolami, Francesca, Mazzarotto, Francesco, Chiostri, Marco, Milli, Massimo, Marchionni, Niccolò, Castelli, Gabriele
• Format: Article
• Language: English
• Subjects: Anthracycline cardiomyopathy; Anthracycline cardiotoxicity; Anthracyclines - adverse effects; Cardiomyopathy, Dilated - epidemiology; Cardiomyopathy, Dilated - etiology; Cardiomyopathy, Dilated - physiopathology; Cardio‐oncology; Disease Progression; Echocardiography; Female; Follow-Up Studies; Forecasting; Heart failure; Heart Ventricles - diagnostic imaging; Heart Ventricles - physiopathology; Humans; Incidence; Italy - epidemiology; Left ventricular dysfunction; Male; Middle Aged; Prognosis; Retrospective Studies; Risk Factors; Severity of Illness Index; Stroke Volume - physiology; Survival Rate - trends; Ventricular Function, Left - physiology
• ISSN: 1388-9842; 1879-0844
• DOI: 10.1002/ejhf.1049

Aims Cardiac dysfunction is a severe complication of anthracycline‐containing anticancer therapy. The outcome of anthracycline‐induced cardiomyopathy (AICM) compared with other non‐ischaemic causes of heart failure (HF), such as idiopathic dilated cardiomyopathy (IDCM), is unresolved. The aim of this study was to compare the survival of AICM patients with an IDCM cohort followed at our centre from 1990 to 2016. Methods and results We included 67 patients (67% female, 50 ± 15 years) with AICM, defined as onset of otherwise unexplained left ventricular ejection fraction (LVEF) ≤50% following anthracycline therapy, and 488 IDCM patients (28% female, 55 ± 12 years). Patients were followed with constantly optimized HF therapy, for 7.6 ± 5.5 and 8.1 ± 5.5 years, respectively. In both cohorts, 25% of patients reached the combined endpoint of death/heart transplantation. Overall survival rates at 5 and 10 years were similar (AICM: 86% and 61%, IDCM: 88% and 75%; P = 0.61), and so was cardiovascular survival (AICM: 91% and 76%, IDCM: 91% and 80%; P = 0.373), also after 1:1 propensity matching (P = 0.27) and adjusting for age, LVEF and left ventricular size. A trend toward higher all‐cause mortality was present in AICM patients [hazard ratio (HR) 1.67, 95% confidence interval (CI) 0.95–2.92, P = 0.076]. No differences were observed between AICM and IDCM with regard to pharmacological HF therapy, but AICM patients were less likely to receive devices (13% vs. 41.8% in IDCM, P