Cardiac Resynchronization Therapy Helps Cancer Survivors With Heart Failure

Cardiac resynchronization therapy (CRT) improved left ventricular ejection fraction (LVEF) after six months in cancer survivors with chemotherapy-induced cardiomyopathy, according to a study published in JAMA.

The uncontrolled, prospective, cohort Multicenter Automatic Defibrillator Implantation Trial–Chemotherapy-Induced Cardiomyopathy study was conducted between November 21, 2014, and June 21, 2018, at 12 U.S. tertiary centers with cardio-oncology programs.

A total of 30 patients (mean age, 64 years) were implanted with CRT due to reduced LVEF (defined as ≤35%), New York Heart Association class II-IV heart failure symptoms, and wide QRS complex, with established chemotherapy-induced cardiomyopathy. Among this cohort, 73% had a history of breast cancer and 20% had a history of lymphoma or leukemia. Twenty-six patients were evaluable for primary endpoint data (change in LVEF from baseline to six months after CRT initiation).

Patients had non-ischemic cardiomyopathy with left bundle branch block, a median LVEF of 29%, and a mean QRS duration of 152 ms.

Improved outcomes with CST

Patients with CRT experienced a statistically significant improvement in mean LVEF at six months, up from 28% to 39% (95% CI, 8.0-13.3; P<0.001). Patients with CRT also had a reduction in left ventricular (LV) end-systolic volume from 122.7 to 89.0 mL (95% CI, 28.2-45.8), as well as a reduction in LV end-diastolic volume from 171.0 to 143.2 mL (95% CI, 22.1-41.6; P<0.001 for both).

Treatment-related adverse events included a procedure-related pneumothorax (n=1), a device pocket infection (n=1), and heart failure requiring hospitalization during follow-up (n=1).

The study is limited by its small patient cohort, short duration of follow-up, and lack of control group.