Prognosis After Withdrawal of Cardioprotective Therapy in Patients With Improved Cancer Therapeutics–Related Cardiac Dysfunction

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology Pub Date : 2024-10-01 DOI:10.1016/j.jaccao.2024.07.018

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引用次数: 0

Abstract

Background

The long-term prognosis after the discontinuation of cardioprotective therapy (CPT) in patients with cancer therapeutics–related cardiac dysfunction (CTRCD) that has shown improvement remains unclear.

Objectives

This study aims to assess the prognosis after CPT withdrawal in patients exhibiting improved CTRCD.

Methods

In this retrospective analysis of a single-center prospective cohort study, patients with improved CTRCD, defined as an increase in left ventricular ejection fraction (LVEF) ≥10 percentage points from the time of CTRCD diagnosis, were included. We analyzed their clinical outcomes, which included hospitalization for heart failure or a decrease in LVEF ≥10 percentage points within 2 years after CTRCD improvement, alongside echocardiographic changes.

Results

The cohort comprised 134 patients with improved CTRCD. The median follow-up duration after CTRCD diagnosis was 368.3 days (Q1-Q3: 160-536 days). After improvement, 90 patients continued CPT (continued group [CG]) and 44 withdrew CPT (withdrawn group [WG]). Among patients whose baseline LVEF at CTRCD diagnosis ranged from 45% to 55%, the final mean LVEF was comparable between both groups (CG: 64.9% ± 4.4% vs WG: 62.9% ± 4.2%; P = 0.059). However, for patients with a baseline LVEF <45%, the final mean LVEF was significantly lower in the WG (CG: 53.3% ± 6.4% vs WG: 48.2% ± 6.9%; P < 0.001). The occurrence of composite major clinical events was notably higher in the WG (HR: 3.06; 95% CI: 1.51-7.73; P = 0.002).

Conclusions

Patients who withdrew CPT after demonstrating improvement in CTRCD experienced worse clinical outcomes. Notably, a significant decrease in LVEF was observed after CPT withdrawal in patients with a baseline LVEF <45%.

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癌症治疗相关心功能障碍改善患者停用心脏保护疗法后的预后情况

背景癌症治疗相关心功能不全（CTRCD）患者停用心脏保护疗法（CPT）后的长期预后仍不明确。目的本研究旨在评估CTRCD改善患者停用CPT后的预后。方法在这项对单中心前瞻性队列研究的回顾性分析中，纳入了 CTRCD 改善的患者（定义为左室射血分数（LVEF）比 CTRCD 诊断时增加≥10 个百分点）。我们对他们的临床结果进行了分析，其中包括因心力衰竭住院或 CTRCD 改善后 2 年内 LVEF 下降≥10 个百分点，以及超声心动图的变化。CTRCD 诊断后的中位随访时间为 368.3 天（Q1-Q3：160-536 天）。病情好转后，90 名患者继续接受 CPT 治疗（继续治疗组 [CG]），44 名患者退出 CPT 治疗（退出治疗组 [WG]）。在确诊 CTRCD 时基线 LVEF 为 45% 至 55% 的患者中，两组的最终平均 LVEF 相当（CG：64.9% ± 4.4% vs WG：62.9% ± 4.2%；P = 0.059）。然而，对于基线 LVEF 为 45% 的患者，WG 组的最终平均 LVEF 明显较低（CG：53.3% ± 6.4% vs WG：48.2% ± 6.9%；P <0.001）。WG发生复合主要临床事件的比例明显更高（HR：3.06；95% CI：1.51-7.73；P = 0.002）。值得注意的是，基线 LVEF 为 45% 的患者在停用 CPT 后 LVEF 明显下降。

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

Jacc: Cardiooncology Multiple-

CiteScore

12.50

自引率

6.30%

发文量

106

期刊介绍： JACC: CardioOncology is a specialized journal that belongs to the esteemed Journal of the American College of Cardiology (JACC) family. Its purpose is to enhance cardiovascular care for cancer patients by publishing high-quality, innovative scientific research and sharing evidence-based knowledge. The journal aims to revolutionize the field of cardio-oncology and actively involve and educate professionals in both cardiovascular and oncology fields. It covers a wide range of topics including pre-clinical, translational, and clinical research, as well as best practices in cardio-oncology. Key areas of focus include understanding disease mechanisms, utilizing in vitro and in vivo models, exploring novel and traditional therapeutics (across Phase I-IV trials), studying epidemiology, employing precision medicine, and investigating primary and secondary prevention. Amyloidosis, cardiovascular risk factors, heart failure, and vascular disease are some examples of the disease states that are of particular interest to the journal. However, it welcomes research on other relevant conditions as well.