Recovery of Left Ventricular Ejection Fraction in Patients With Anthracycline-Induced Cardiomyopathy: A Contemporary Cohort Study

Abstract

Background

Data on left ventricular ejection fraction (LVEF) recovery in patients with anthracycline-induced cardiomyopathy (AIC) are limited.

Objectives

To evaluate LVEF recovery rate, its predictors and its association with cardiovascular outcomes in a contemporary and diverse cohort with AIC.

Methods

This retrospective study analyzed patients diagnosed with AIC from 2010–2023 at 2 U.S. university hospitals and an affiliated cancer center. LVEF recovery, defined as ≥ 10% improvement in LVEF to a value ≥ 50% within 3 years of AIC detection, was assessed by using Cox proportional-hazards accounting for competing risks. The association between LVEF recovery and the composite of heart failure (HF) hospitalizations, mechanical circulatory support, heart transplantation, or cardiovascular death was assessed by using Cox regression analysis with LVEF recovery as a time-dependent factor.

Results

Among 167 patients with anthracycline-induced cardiomyopathy (AIC) (median age 67 [Q1, Q3: 53, 74] years, 53% female), the majority had lymphoma (55%) or breast cancer (23%). The median time from first anthracycline exposure to AIC detection was 631 (219, 3569) days, and the median LVEF was 38% (29%, 45%). At the detection of AIC, 69% had symptomatic HF. LVEF recovered in 38% (n = 63) at a median of 349 (137, 691) days from AIC detection. Age ≥ 60 years at anthracycline exposure, non-white race, diabetes mellitus, longer interval between anthracycline exposure and AIC detection, and LV dilation were associated with a lower likelihood of recovery, while statin use and AIC detection after 2022 were associated with a higher likelihood of recovery. LVEF recovery was not associated with cardiovascular outcomes.

Conclusion

In this contemporary and diverse AIC cohort, 38% achieved LVEF recovery. Routine screening for AIC and statin therapy may improve recovery rates.