Association of Cardiac Resynchronization Therapy With Change in Left Ventricular Ejection Fraction in Patients With Chemotherapy-Induced Cardiomyopathy
| Autor: | Jagmeet P. Singh, Ilan Goldenberg, Susan Schleede, Ana Barac, Michael G. Fradley, Christopher A. Beck, Kristina A. Kremer, Scott McNitt, Scott D. Solomon, Valentina Kutyifa, Mary W. Brown, Wojciech Zareba |
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| Rok vydání: | 2019 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Mean QRS Duration Cardiomyopathy Cardiac resynchronization therapy 01 natural sciences 03 medical and health sciences 0302 clinical medicine Internal medicine medicine cardiovascular diseases 030212 general & internal medicine 0101 mathematics Prospective cohort study Ejection fraction business.industry Left bundle branch block 010102 general mathematics General Medicine Stroke volume medicine.disease Heart failure cardiovascular system Cardiology business circulatory and respiratory physiology |
| Zdroj: | JAMA. 322:1799 |
| ISSN: | 0098-7484 |
| Popis: | Importance The incidence of chemotherapy-induced cardiomyopathy is increasing and is associated with poor clinical outcomes. Objective To assess the association of cardiac resynchronization therapy (CRT) with improvement in cardiac function, as well as clinical improvement in patients with chemotherapy-induced cardiomyopathy. Design, Setting, and Participants The Multicenter Automatic Defibrillator Implantation Trial–Chemotherapy-Induced Cardiomyopathy was an uncontrolled, prospective, cohort study conducted between November 21, 2014, and June 21, 2018, at 12 tertiary centers with cardio-oncology programs in the United States. Thirty patients were implanted with CRT owing to reduced left ventricular ejection fraction (LVEF≤35%), New York Heart Association class II-IV heart failure symptoms, and wide QRS complex, with established chemotherapy-induced cardiomyopathy and were followed up for 6 months after CRT implantation. The date of final follow-up was February 6, 2019. Exposures CRT implantation according to standard of care. Main Outcomes and Measures The primary end point was change in LVEF from baseline to 6 months after initiating CRT. Secondary outcomes included all-cause mortality and change in left ventricular end-systolic volume and end-diastolic volume. Results Among 30 patients who were enrolled (mean [SD] age, 64 [11] years; 26 women [87%]; 73% had a history of breast cancer; 20% had a history of lymphoma or leukemia), primary end point data were available for 26 patients and secondary end point data were available for 23 patients. Patients had nonischemic cardiomyopathy with left bundle branch block, median LVEF of 29%, and a mean QRS duration of 152 ms. Patients with CRT experienced a statistically significant improvement in mean LVEF at 6 months from 28% to 39% (difference, 10.6% [95% CI, 8.0%-13.3%];P Conclusions and Relevance In this preliminary study of patients with chemotherapy-induced cardiomyopathy, CRT was associated with improvement in LVEF after 6 months. The findings are limited by the small sample size, short follow-up, and absence of a control group. Trial Registration ClinicalTrials.gov Identifier:NCT02164721 |
| Databáze: | OpenAIRE |
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