Heart Transplantation in Adriamycin-Associated Cardiomyopathy in the Contemporary Era of Advanced Heart Failure Therapies

Bhavadharini Ramu; Maria Masotti; Ryan J Tedford; Rebecca J Cogswell

doi:10.1016/j.jaccao.2021.02.010

Heart Transplantation in Adriamycin-Associated Cardiomyopathy in the Contemporary Era of Advanced Heart Failure Therapies

JACC CardioOncol. 2021 Jun 15;3(2):294-301. doi: 10.1016/j.jaccao.2021.02.010. eCollection 2021 Jun.

Authors

Bhavadharini Ramu¹, Maria Masotti², Ryan J Tedford¹, Rebecca J Cogswell³

Affiliations

¹ Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
² School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
³ Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.

Abstract

Background: Adriamycin-associated cardiomyopathy (ACM) can lead to end-stage heart failure requiring advanced heart failure therapies.

Objectives: This study sought to provide post-cardiac transplant survival data in patients with ACM in the contemporary era of mechanical circulatory support and cardiac transplantation.

Methods: Adults (≥18 years of age) who underwent first-time, single-organ heart transplantation were identified from the United Network for Organ Sharing between October 18, 2008, and October 18, 2018. Cardiomyopathy subtypes that could have been supported with a left ventricular assist device (LVAD) including ACM, dilated cardiomyopathy (DCM), and ischemic cardiomyopathy (ICM) were included. A multivariable Cox regression analysis was performed to determine the association between cardiomyopathy subtype and post-cardiac transplant survival.

Results: This analysis included 18,270 patients (357 with ACM; 10,662 with DCM; and 7,251 with ICM). Heart transplant recipients with ACM were younger, included more women, and had higher pulmonary vascular resistance at the time of listing. Patients with ACM had a lower percentage of durable LVADs at the time of transplant across all years of the study period. Patients with ACM did not experience an increase in post-cardiac transplant mortality compared to those with DCM (adjusted hazard ratio: 0.96; 95% confidence interval: 0.79 to 1.40; p = 0.764) or ICM (adjusted hazard ratio: 0.85; 95% confidence interval: 0.6 to 1.2; p = 0.304).

Conclusions: Patients with ACM who received heart transplants between 2008 and 2018 had similar post-cardiac transplant survival to those with dilated and ischemic cardiomyopathy. Bridge-to-transplant LVAD use remains lower compared to other cardiomyopathy subtypes.

Keywords: ACM, adriamycin-associated cardiomyopathy; CI, confidence interval; DCM, dilated cardiomyopathy; HR, hazard ratio; ICM, ischemic cardiomyopathy; IQR, interquartile range; LVAD, left ventricular assist device; OR, odds ratio; UNOS, United Network for Organ Sharing; adriamycin cardiomyopathy; cardiac transplantation; left ventricular assist device.