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Observational Study
. 2019 Jan;105(1):34-41.
doi: 10.1136/heartjnl-2018-313234. Epub 2018 May 15.

Cardiovascular phenotype and prognosis of patients with heart failure induced by cancer therapy

Wilson Nadruz Jr  1   2 , Erin West  1 , Morten Sengeløv  1 , Gabriela L Grove  1 , Mário Santos  3 , John D Groarke  1 , Daniel E Forman  4 , Brian Claggett  1 , Hicham Skali  1 , Anju Nohria  1 , Amil M Shah  1
Affiliations
Observational Study

Cardiovascular phenotype and prognosis of patients with heart failure induced by cancer therapy

Wilson Nadruz Jr et al. Heart. 2019 Jan.

Abstract

Objective: This study compared the clinical features, cardiac structure and function evaluated by echocardiography, cardiopulmonary response to exercise and long-term clinical outcomes between patients with heart failure (HF) induced by cancer therapy (CTHF) and heart failure not induced by cancer therapy (NCTHF).

Methods: We evaluated 75 patients with CTHF and 894 with NCTHF who underwent clinically indicated cardiopulmonary exercise testing, and followed these individuals for a median of 4.5 (3.0-5.8) years, during which 187 deaths and 256 composite events (death, heart transplantation and left ventricular (LV) assistant device implantation) occurred.

Results: Compared with NCTHF, patients with CTHF were younger, with lower prevalence of cardiovascular comorbidities, higher LV ejection fraction (LVEF), but similar global longitudinal strain. LV diastolic function (higher E/e' ratio) and compliance (higher end-diastolic pressure/LV end-diastolic volume index ratio) were worse in CTHF and were both associated with adverse outcomes. Despite a favourable clinical profile, peak VO2 and VE/VCO2 slope were similarly impaired in CTHF and NCTHF. In multivariable Cox regression analysis including clinical characteristics, cardiopulmonary exercise testing variables and LVEF, CTHF was associated with a significantly higher risk of death (HR 2.64; 95% CI 1.53 to 4.55; p=0.001) and composite events (HR 1.79; 95% CI 1.10 to 2.91; p=0.019) compared with NCTHF.

Conclusions: CTHF is characterised by a distinct clinical profile, better LVEF but worse LV diastolic properties, and similarly impaired global longitudinal strain, functional capacity and ventilatory efficiency. Accounting for differences in clinical characteristics, CTHF was associated with worse long-term prognosis than NCTHF.

Keywords: cancer; cardiopulmonary exercise testing; diastolic function; heart failure; strain.

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Conflict of interest statement

Competing interests: AMS reports receiving research support from Novartis and Bellerophron, and consulting fees from Philips Ultrasound. The other authors have nothing to disclose.

Figures

Figure 1
Figure 1
Kaplan-Meier curves for death and composite endpoint. The composite endpoint was defined as the composite outcome of left ventricular assistant device implantation, heart transplantation or all-cause mortality. CTHF, cancer therapy-induced heart failure; NCTHF, non-cancer therapy-induced heart failure.
See this image and copyright information in PMC

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References

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