Patients with anthracycline-related cardiomyopathy do not have a greater incidence of arrhythmia compared to patients without cancer who have ischemic heart disease-related left ventricular dysfunction (LVD) or dilated cardiomyopathy, according to a retrospective cohort study published in JACC: Clinical Electrophysiology.

Researchers from the Division of Cardiovascular Diseases and the Department of Health Sciences Research at the Mayo Clinic sought to determine the potential burden of arrhythmias in adult cancer survivors with anthracycline-related cardiomyopathy compared to cancer survivors with non-anthracycline-related cardiomyopathy and non-cancer patients with dilated cardiomyopathy or an internal cardiac defibrillator.

Of the 95 patients with a previous cancer diagnosis, 23 had anthracycline-related cardiomyopathy and 72 had non-anthracycline-related cardiomyopathy. Patients had been diagnosed with either lymphoma, breast cancer, and renal or pelvis cancer. A control group included 68 non-cancer patients with either ischemic heart disease-related LVD (n=68) or dilated cardiomyopathy (n=45). Patients with anthracycline exposure were matched 3:1 to non-cancer patients from both groups (ischemic heart disease-LVD or dilated cardiomyopathy).


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The 2 most commonly identified arrhythmias in patients with  anthracycline-related cardiomyopathy were nonsustained ventricular tachycardia (VT) followed by atrial fibrillation (AF)/flutter. Ofthe patients with AF/flutter who had anthracycline-related cardiomyopathy, 69% were undergoing anticoagulation therapy compared to 31.4% in the non anythracycline-related cardiomyopathy (P =.02) and 59.5% in the ischemic heart disease/dilated cardiomyopathy group (P =.53).

During follow-up, patients in the anthracycline-related cardiomyopathy population experienced  relatively unchanged averages in their New York Heart Association (NYHA) class (anthracycline-related cardiomyopathy group, 2.3±.08 to 2.4±1.1; non anthracycline-realyed cardiomyopathy group, 2.1±0.9 to 2.4±1.0; ischemic heart disease/dialated cardiomypathy group, 2.4±0.9 to 2.3±0.9).

Three patients in the anthracycline-related cardiomyopathy group underwent heart transplantation/LVAD implantation compared to 5 patients in the non antrhacycline-related cardiomyopathy group and 4 in the ischemic heart disease/dilated cardiomyopathy group (5-year rates were 12.9%, 7% [P=.37], and 5.4% [P =.36], respectively).

In terms of survival, 7 patients with anthracycline-related cardiomyopathy died, 26 patients with non anthracycline-related cardiomyopathy died, and 23 ischemic heart disease/dilated cardiomyopathy patients died (5-year mortality rates were 13.5%, 31.8% [P =.44], and 19.7% [P =.32], respectively). Outcomes did not change when patients with histories of myocardial infarction or coronary revascularization were excluded.

The researchers noted that this study is the first comprehensive analysis of arrhythmias in long-term adult cancer survivors with cardiomyopathy, which showed that malignant arrhythmias and progressive heart failure are leading causes of mortality in patients with cardiomyopathy.

“[T]he fraction of patients with anthracycline-related cardiomyopathy who experienced recovery of their cardiac function was similar to cancer patients with cardiomyopathy without anthracycline exposure and non-cancer patients with [ischemic heart disease]-related LVD and dilated cardiomyopathy,” the authors concluded. “These observations challenge the view of an unrelenting disease course of anthracycline-related cardiomyopathy and should stimulate further larger scale studies in the current area of heart failure therapies.”

Study Limitations

  • The study was limited by the small number of patients, although researchers noted that these types of patients are not easy to identify or characterize.
  • Only cancer patients with devices were included, which may have introduced a selection bias towards those with better projected outcomes.
  • Findings were obtained in an exclusively adult cancer population.

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Disclosures: This study was supported by research funding from the Division of Cardiovascular Diseases, Mayo Clinic Rochester.

Reference

Mazur M, Wang F, Hodge D, et al. Burden of cardiac arrhythmias in patients with anthracycline-related cardiomyopathy. JACC Clin Electrophysiol. 2016. doi:10.1016/j.jacep.2016.08.009.