Increased need for right ventricular support in patients with chemotherapy-induced cardiomyopathy undergoing mechanical circulatory support: outcomes from the INTERMACS Registry (Interagency Registry for Mechanically Assisted Circulatory Support)

J Am Coll Cardiol. 2014 Jan 28;63(3):240-8. doi: 10.1016/j.jacc.2013.09.040. Epub 2013 Oct 23.

Abstract

Objectives: The aim of this study was to investigate the use of durable mechanical circulatory support (MCS) in patients with chemotherapy-induced cardiomyopathy (CCMP) and determine their outcomes and survival in comparison to that of other patients with end-stage heart failure treated similarly.

Background: Patients with end-stage heart failure as a result of CCMP from anthracyclines are often precluded from heart transplantation because of a history of cancer. In such patients, durable MCS may offer an important chance for life prolongation. Yet, there are no data to support the use of MCS in this increasingly prevalent group of patients.

Methods: We searched 3,812 MCS patients from June 2006 through March 2011 in the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) database for the diagnosis of CCMP. We compared characteristics, outcomes, and survival between CCMP patients and patients with nonischemic cardiomyopathy and ischemic cardiomyopathy.

Results: Compared with patients with nonischemic cardiomyopathy and ischemic cardiomyopathy, patients with CCMP were overwhelmingly female (72% vs. 24% vs. 13%, p = 0.001), had MCS more often implanted as destination therapy (33% vs. 14% vs. 22%, p = 0.03), required more right ventricular assist device support (19% vs. 11% vs. 6%, p = 0.006), and had a higher risk of bleeding (p = 0001). Survival of CCMP patients was similar to that of other groups.

Conclusions: CCMP patients treated with MCS have survival similar to other MCS patients despite more frequent need for right ventricular assist device support and increased bleeding risk.

Keywords: CCMP; ICMP; LVAD; MCS; NICMP; RV; RVAD; assist devices; chemotherapy-induced cardiomyopathy; heart failure; ischemic cardiomyopathy; left ventricular assist device; mechanical circulatory support; nonischemic cardiomyopathy; right ventricular; right ventricular assist device.

Publication types

  • Comparative Study
  • Multicenter Study

MeSH terms

  • Antineoplastic Agents / adverse effects*
  • Antineoplastic Agents / therapeutic use
  • Cardiomyopathies / chemically induced
  • Cardiomyopathies / mortality
  • Cardiomyopathies / therapy*
  • Cause of Death / trends
  • Female
  • Follow-Up Studies
  • Heart-Assist Devices / trends*
  • Humans
  • Male
  • Middle Aged
  • Neoplasms / drug therapy
  • Registries*
  • Retrospective Studies
  • Survival Rate / trends
  • Treatment Outcome
  • United States / epidemiology

Substances

  • Antineoplastic Agents