A Matched Cohort Study of Patients with End-stage Heart Failure from Anthracycline-Induced Cardiomyopathy Requiring Advanced Cardiac Support

Abstract Anthracycline-induced cardiomyopathy (AIC) may progress to end-stage heart failure requiring mechanical circulatory support or orthotopic heart transplantation (OHT). Previous studies have described important clinical differences between AIC and non-ischemic cardiomyopathy (NIC) cohorts requiring these advanced interventions. Therefore, we sought to extend this literature by comparing echocardiography parameters, treatment strategies, and the prognosis between matched patients from these cohorts. This is a retrospective matched cohort study. All patients who received a ventricular assist device (VAD) or OHT at a large Canadian center were reviewed (N=421; 1988-2015) and individuals with clinical and pathological evidence of AIC were included (N=17, 4.0%). A comparison cohort with idiopathic NIC from the same database, matched 3:1 for age, sex, ethnicity, and year of heart failure onset was selected. The Mann-Whitney Rank Sum and Fisher's Exact tests were used for comparisons. AIC patients were predominantly female (70.6%) with heart failure diagnosed at age 40.2±15.8 years and 8.3±8.9 years following anthracycline treatment. When compared to NIC, no differences were seen in co-morbidities, echocardiographic measures, the proportion of patients receiving a defibrillator, VAD, or OHT, the incidence of graft failure, and all-cause mortality. In contrast to other studies, AIC was not associated with a higher incidence of right ventricular dysfunction. A greater proportion of AIC patients developed cancer (recurrence or new primary) post-OHT (21.4% vs. 2.3%, p=0.042). In conclusion, we demonstrate that when matched cohorts of patients with end-stage heart failure secondary to AIC and idiopathic NIC are compared, they are similar with respect to co-morbidities, degree of ventricular dysfunction, and advanced therapeutics employed. The prognosis with OHT is also similar.