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Cardiac resynchronization therapy in anthracycline-induced cardiomyopathy
Session:
Posters (Sessão 1 - Écran 2) - Cardio-oncologia
Speaker:
Beatriz Valente Silva
Congress:
CPC 2023
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.6 Cardio-Oncology
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Beatriz Valente Silva; Andreia Magalhães; Miguel Nobre Menezes; Paula Costa; Catarina Gregório; Pedro Alves da Silva; Beatriz Garcia; Catarina Oliveira; Ana Margarida Martins; Miguel Raposo; Ana Abrantes; Pedro Marques; João de Sousa; Fausto J Pinto; Manuela Fiuza
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Introduction:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Chemotherapy-induced cardiomyopathy has been increasingly recognised as patients (pts) are living longer with more effective treatments for cancer. Anthracyclines are known to cause heart failure (HF) and besides pharmacological treatment, some pts may be considered for cardiac resynchronization therapy (CRT). However, the role of CRT in anthracycline-induced cardiomyopathy (AIC) remains a matter of debate.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Methods:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">We performed a retrospective study of all pts undergoing CRT implantation at our center from 2011 to 2022, with a diagnosis of AIC (study group). Echocardiographic and clinical outcomes of these pts were compared to a control group with dilated myocardiopathy other than AIC.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Results</strong>:</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">A total of 15 pts underwent CRT implantation with a diagnosis of AIC (43% male, mean age 66 ± 13 years) – study group. The most prevalent comorbidities were hypertension (86%), obesity (50%), diabetes (36%) and dyslipidemia (43%). Mean NYHA functional class pre-CRT implantation was II and mean NTproBNP was 7900 ng/L.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">The control group included 15 pts with no differences regarding age, gender, comorbidities, NYHA functional class, left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) compared to study group. Control group presented higher number of pts under angiotensin-converting enzyme inhibitors and spironolactone compared to study group (100 vs 67%, p=0.014; 47% vs 7%, p=0.013, respectively); no differences were found for beta-blockers and SGLT2 inhibitors.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Study group demonstrated a significant increase of LVEF (from 30 ± 4% to 47 ± 9%, p=0.005) and a significant decrease of LVEDV (from 165 ± 49mL to 115 ± 24mL, p=0.021) and LVESV (from 109 ± 40mL to 63 ± 19mL, p=0.011) after CRT implant. The same was verified for the control group. No difference was found regarding post-CRT LVEF, LVEDV and LVESV between groups. CRT <em>responders</em> (defined as improvement of LVEF > 5%) totalized 67% (N=10) in the study group and 80% (N=12) in the control group, which reflects a similar response for both groups (p=0.557). In both groups, <em>super responders </em>(improvement of LVEF >10%) occurred in 8 pts.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Post-CRT improvement of NYHA occurred only for the study group (p=0.007), although without significant decrease in NTproBNP levels.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">Three pts of the study group died during the follow-up, and although no deaths occurred in the control group, the difference was not statistically significant (p=0.068).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><strong>Conclusion:</strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif">This study demonstrated that CRT is an effective therapy for pts with anthracycline-induced cardiomyopathy, with expected benefit comparable to other dilated myocardiopathies. </span></span></p> <p> </p>
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