Evaluation of Midodrine Utilization in Patients with Cancer and Heart Failure.

IF 3.1 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Drugs and Therapy Pub Date : 2025-06-01 Epub Date: 2024-01-15 DOI:10.1007/s10557-024-07546-4

Jorge A Irizarry-Caro, Juhee Song, Chase Miller, Shyam Desai, James Going, Jose Fossas-Espinosa, Mariya M Fatakdawala, Abdelrahman Ali, Cezar Iliescu, Nicolas Palaskas, Anita Deswal, Efstratios Koutroumpakis

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引用次数: 0

Abstract

Purpose: The purpose of this study was to evaluate safety and cardiovascular outcomes as well as overall survival of cancer patients with concomitant heart failure (HF) treated with midodrine for hypotension.

Methods: Adult patients diagnosed with cancer and HF who were treated with midodrine at a tertiary cancer center from 03/2013 to 08/2021 were identified. Demographic and clinical parameters were collected retrospectively.

Results: A total of 85 patients were included with a median age of 68 years (IQR: 60, 74; 33% female and 85% White). Of those, 31% had HFpEF (EF ≥ 50%), 42% HF with mildly reduced EF (HFmrEF; EF 41-49%), and 27% HFrEF (EF ≤ 40%). The most common indication for midodrine use was orthostatic hypotension (49%). Midodrine was continued for at least one month in 57% of the patients. Supine hypertension was the only side effect reported in 6% of patients. No statistically significant changes in NYHA class, guideline-directed medical therapy, cardiac biomarkers (NT-proBNP or troponin T), echocardiographic findings or cardiovascular hospitalizations were observed between patients who continued treatment with midodrine compared to those who stopped using midodrine over a median follow-up of 38 months. In the multivariable cox regression analysis, continuation of midodrine, compared to discontinuation, and use of midodrine for orthostatic hypotension, as opposed to other causes of hypotension, were not associated with an increased risk of mortality (HR 0.41, 95% CI 0.24-0.69, p < .0001; HR 0.34, 95% CI 0.18-0.64, p < .001, respectively). In contrast, elevated creatinine (> 1.3 for males and > 1.1 for females) was associated with an increased risk of mortality (HR 1.83, 95% CI 1.07-3.14). LVEF was not significantly associated with lower or higher risk of mortality.

Conclusions: In our study, midodrine use in patients with cancer and HF was not associated with significant adverse effects, worse cardiovascular outcomes, or increased risk of mortality. Larger, prospective studies are needed to confirm these findings.

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评估癌症和心力衰竭患者使用米多君的情况

目的：本研究旨在评估使用米多君治疗低血压的合并心力衰竭（HF）的癌症患者的安全性、心血管预后以及总生存率：方法：研究对象为2013年3月至2021年8月期间在一家三级癌症中心接受米多君治疗的癌症合并心力衰竭成人患者。结果：共纳入 85 例癌症合并心房颤动的成人患者，他们均患有低血压：共纳入 85 名患者，中位年龄为 68 岁（IQR：60-74；33% 为女性，85% 为白人）。其中，31%的患者患有 HFpEF（EF ≥ 50%），42%的患者患有 EF 轻度降低的 HF（HFmrEF；EF 41-49%），27%的患者患有 HFrEF（EF ≤ 40%）。使用米多君最常见的适应症是正性低血压（49%）。57%的患者持续使用米多君至少一个月。仰卧位高血压是 6% 的患者报告的唯一副作用。在中位随访 38 个月期间，与停用米多君的患者相比，继续使用米多君治疗的患者在 NYHA 分级、指南指导的药物治疗、心脏生物标志物（NT-proBNP 或肌钙蛋白 T）、超声心动图检查结果或心血管住院治疗方面均未观察到明显的统计学变化。在多变量 cox 回归分析中，与停用相比，继续使用米多君，以及使用米多君治疗直立性低血压（而非其他原因引起的低血压）与死亡风险的增加无关（HR 0.41，95% CI 0.24-0.69，男性 p 1.3，女性 > 1.1），但与死亡风险的增加有关（HR 1.83，95% CI 1.07-3.14）。LVEF与较低或较高的死亡风险无明显相关性：在我们的研究中，癌症合并心房颤动患者使用米多君与明显的不良反应、心血管预后恶化或死亡风险增加无关。需要更大规模的前瞻性研究来证实这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cardiovascular Drugs and Therapy 医学-心血管系统

CiteScore

8.30

自引率

0.00%

发文量

110

审稿时长

4.5 months

期刊介绍： Designed to objectively cover the process of bench to bedside development of cardiovascular drug, device and cell therapy, and to bring you the information you need most in a timely and useful format, Cardiovascular Drugs and Therapy takes a fresh and energetic look at advances in this dynamic field. Homing in on the most exciting work being done on new therapeutic agents, Cardiovascular Drugs and Therapy focusses on developments in atherosclerosis, hyperlipidemia, diabetes, ischemic syndromes and arrhythmias. The Journal is an authoritative source of current and relevant information that is indispensable for basic and clinical investigators aiming for novel, breakthrough research as well as for cardiologists seeking to best serve their patients. Providing you with a single, concise reference tool acknowledged to be among the finest in the world, Cardiovascular Drugs and Therapy is listed in Web of Science and PubMed/Medline among other abstracting and indexing services. The regular articles and frequent special topical issues equip you with an up-to-date source defined by the need for accurate information on an ever-evolving field. Cardiovascular Drugs and Therapy is a careful and accurate guide through the maze of new products and therapies which furnishes you with the details on cardiovascular pharmacology that you will refer to time and time again.