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

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).

Author information

  • 1Advanced Heart Failure and Transplantation Center, Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio. Electronic address: guilherme.oliveira@UHhospitals.org.
  • 2Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
  • 3Cardiovascular Surgery Research, University of Alabama at Birmingham, Birmingham, Alabama.
  • 4Advanced Heart Failure and Transplantation Center, Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio.
  • 5Department of Cardiothoracic Surgery, Baylor Medical Center, Dallas, Texas.

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.

Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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

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PMID:
24161324
[PubMed - indexed for MEDLINE]
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