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Incidence and outcomes of cancer treatment-related cardiomyopathy among referrals for advanced heart failure

BACKGROUND: Approximately 2–3% of patients undergoing advanced heart failure therapies such as left ventricular assist devices (LVAD) and orthotropic heart transplantation (OHT) have chemotherapy-related cardiomyopathy, according to analyses of large databases such as United Network for Organ Sharin...

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Autores principales: Araujo-Gutierrez, Raquel, Ibarra-Cortez, Sergio H., Estep, Jerry D., Bhimaraj, Arvind, Guha, Ashrith, Hussain, Imad, Park, Myung H., Torre-Amione, Guillermo, Trachtenberg, Barry H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7048122/
https://www.ncbi.nlm.nih.gov/pubmed/32154004
http://dx.doi.org/10.1186/s40959-018-0029-y
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author Araujo-Gutierrez, Raquel
Ibarra-Cortez, Sergio H.
Estep, Jerry D.
Bhimaraj, Arvind
Guha, Ashrith
Hussain, Imad
Park, Myung H.
Torre-Amione, Guillermo
Trachtenberg, Barry H.
author_facet Araujo-Gutierrez, Raquel
Ibarra-Cortez, Sergio H.
Estep, Jerry D.
Bhimaraj, Arvind
Guha, Ashrith
Hussain, Imad
Park, Myung H.
Torre-Amione, Guillermo
Trachtenberg, Barry H.
author_sort Araujo-Gutierrez, Raquel
collection PubMed
description BACKGROUND: Approximately 2–3% of patients undergoing advanced heart failure therapies such as left ventricular assist devices (LVAD) and orthotropic heart transplantation (OHT) have chemotherapy-related cardiomyopathy, according to analyses of large databases such as United Network for Organ Sharing (UNOS) or Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) registries. While these studies have shown similar survival outcomes post-interventions, these databases by definition exclude patients referred for advanced therapies but do not receive them, and thus there is little data on overall outcomes of such patients. Given the lack of nuance in the diagnoses in large registries and the possibility that many cancer treatment-related cardiomyopathy (CCMP) patients might be misclassified by the generic “non-ischemic” or “dilated” cardiomyopathies, we investigated the incidence and clinical outcomes of CCMP patients among advanced heart failure (HF) referrals at a single high volume institution. METHODS: All referrals from 2013 to 2016 were evaluated for type of cardiomyopathy, with careful chart review. Outcomes such as LVAD, OHT and death were compared between CCMP and other cardiomyopathies. RESULTS: Of 553 referrals for advanced HF, 19 (3.4%) were for CCMP. There was a higher percentage of patients receiving advanced therapies in the CCMP vs. non-ischemic cardiomyopathy (NICMP) and ischemic cardiomyopathy (ICMP) (42.1% vs 30.2% vs 33.6%, not significant). Of the CCMP patients, 3 had OHT directly, 2 had LVAD followed by OHT, and 3 had LVADs as bridge to candidacy or destination therapy. Fifty-eight percent of the CCMP did not receive LVAD or OHT compared to 69.8% and 66.3 of the NICMP and ICMP, respectively (p = 0.0388). Independent of type of advanced therapy, survival was significantly higher in the CCMP group compared to NICMP and ICMP (93.3% vs 84.8% vs 73.8%, respectively P = 0.0021 for 1 year, 93.3% vs 76.2% vs 58.3%, respectively, P = < 0.0001 for 3 year). CONCLUSIONS: In a single institution, CCMP accounts for more than 3% of all referrals for advanced HF therapies and almost 8% of NICMP. Contrary to concerns for previous cancer and sequelae of cancer treatment excluding patients for advanced therapies, a higher percentage of CCMP underwent advanced HF therapies and with similar outcomes. This is the first study to show that among patients referred for advanced therapies, CCMP patients do not have inferior outcomes compared to other cardiomyopathies regardless of the selected management strategy.
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spelling pubmed-70481222020-03-09 Incidence and outcomes of cancer treatment-related cardiomyopathy among referrals for advanced heart failure Araujo-Gutierrez, Raquel Ibarra-Cortez, Sergio H. Estep, Jerry D. Bhimaraj, Arvind Guha, Ashrith Hussain, Imad Park, Myung H. Torre-Amione, Guillermo Trachtenberg, Barry H. Cardiooncology Research BACKGROUND: Approximately 2–3% of patients undergoing advanced heart failure therapies such as left ventricular assist devices (LVAD) and orthotropic heart transplantation (OHT) have chemotherapy-related cardiomyopathy, according to analyses of large databases such as United Network for Organ Sharing (UNOS) or Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) registries. While these studies have shown similar survival outcomes post-interventions, these databases by definition exclude patients referred for advanced therapies but do not receive them, and thus there is little data on overall outcomes of such patients. Given the lack of nuance in the diagnoses in large registries and the possibility that many cancer treatment-related cardiomyopathy (CCMP) patients might be misclassified by the generic “non-ischemic” or “dilated” cardiomyopathies, we investigated the incidence and clinical outcomes of CCMP patients among advanced heart failure (HF) referrals at a single high volume institution. METHODS: All referrals from 2013 to 2016 were evaluated for type of cardiomyopathy, with careful chart review. Outcomes such as LVAD, OHT and death were compared between CCMP and other cardiomyopathies. RESULTS: Of 553 referrals for advanced HF, 19 (3.4%) were for CCMP. There was a higher percentage of patients receiving advanced therapies in the CCMP vs. non-ischemic cardiomyopathy (NICMP) and ischemic cardiomyopathy (ICMP) (42.1% vs 30.2% vs 33.6%, not significant). Of the CCMP patients, 3 had OHT directly, 2 had LVAD followed by OHT, and 3 had LVADs as bridge to candidacy or destination therapy. Fifty-eight percent of the CCMP did not receive LVAD or OHT compared to 69.8% and 66.3 of the NICMP and ICMP, respectively (p = 0.0388). Independent of type of advanced therapy, survival was significantly higher in the CCMP group compared to NICMP and ICMP (93.3% vs 84.8% vs 73.8%, respectively P = 0.0021 for 1 year, 93.3% vs 76.2% vs 58.3%, respectively, P = < 0.0001 for 3 year). CONCLUSIONS: In a single institution, CCMP accounts for more than 3% of all referrals for advanced HF therapies and almost 8% of NICMP. Contrary to concerns for previous cancer and sequelae of cancer treatment excluding patients for advanced therapies, a higher percentage of CCMP underwent advanced HF therapies and with similar outcomes. This is the first study to show that among patients referred for advanced therapies, CCMP patients do not have inferior outcomes compared to other cardiomyopathies regardless of the selected management strategy. BioMed Central 2018-03-20 /pmc/articles/PMC7048122/ /pubmed/32154004 http://dx.doi.org/10.1186/s40959-018-0029-y Text en © The Author(s). 2018 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Araujo-Gutierrez, Raquel
Ibarra-Cortez, Sergio H.
Estep, Jerry D.
Bhimaraj, Arvind
Guha, Ashrith
Hussain, Imad
Park, Myung H.
Torre-Amione, Guillermo
Trachtenberg, Barry H.
Incidence and outcomes of cancer treatment-related cardiomyopathy among referrals for advanced heart failure
title Incidence and outcomes of cancer treatment-related cardiomyopathy among referrals for advanced heart failure
title_full Incidence and outcomes of cancer treatment-related cardiomyopathy among referrals for advanced heart failure
title_fullStr Incidence and outcomes of cancer treatment-related cardiomyopathy among referrals for advanced heart failure
title_full_unstemmed Incidence and outcomes of cancer treatment-related cardiomyopathy among referrals for advanced heart failure
title_short Incidence and outcomes of cancer treatment-related cardiomyopathy among referrals for advanced heart failure
title_sort incidence and outcomes of cancer treatment-related cardiomyopathy among referrals for advanced heart failure
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7048122/
https://www.ncbi.nlm.nih.gov/pubmed/32154004
http://dx.doi.org/10.1186/s40959-018-0029-y
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