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Comparative Study
. 2010 Nov 9;56(20):1644-50.
doi: 10.1016/j.jacc.2010.07.023.

Left Ventricular Dysfunction in Patients Receiving Cardiotoxic Cancer Therapies Are Clinicians Responding Optimally?

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Free PMC article
Comparative Study

Left Ventricular Dysfunction in Patients Receiving Cardiotoxic Cancer Therapies Are Clinicians Responding Optimally?

Geoffrey J Yoon et al. J Am Coll Cardiol. .
Free PMC article

Abstract

Objectives: The purpose of this study was to examine treatment practices for cancer therapy-associated decreased left ventricular ejection fraction (LVEF) detected on echocardiography and whether management was consistent with American College of Cardiology/American Heart Association guidelines.

Background: Patients treated with anthracyclines or trastuzumab are at risk of cardiotoxicity. Decreased LVEF represents a Class I indication for drug intervention according to American College of Cardiology/American Heart Association guidelines.

Methods: Patients receiving anthracycline or trastuzumab at Stanford University from October 2005 to October 2007 and who had undergone echocardiography before and after receiving an anthracycline or trastuzumab were identified. Chart review examined chemotherapy regimens, cardiac risk factors, imaging results, concomitant medications, and cardiology consultations.

Results: Eighty-eight patients received therapy with an anthracycline or trastuzumab and had a pre-treatment and follow-up echocardiogram. Ninety-two percent were treated with anthracyclines, 17% with trastuzumab after an anthracycline, and 8% with trastuzumab without previous treatment with anthracycline. Mean baseline LVEF was 60%, with 14% having a baseline <55%. Forty percent had decreased LVEF (<55%) after anthracycline and/or trastuzumab treatment. Of these patients, 40% received angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy, 51% beta-blocker therapy, and 54% cardiology consultation. Of patients with asymptomatic decreased LVEF, 31% received angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy, 35% beta-blocker therapy, and 42% cardiology consultation. Of those with symptomatic decreased LVEF, 67% received angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy, 100% beta-blocker therapy, and 89% cardiology consultation.

Conclusions: Many cancer survivors are not receiving treatment consistent with heart failure guidelines. There is substantial opportunity for collaboration between oncologists and cardiologists to improve the care of oncology patients receiving cardiotoxic therapy.

Conflict of interest statement

Dr. Matsuda has served as a consultant to Medicure Pharma. All other authors have reported that they have no relationships to disclose.

Figures

Figure 1
Figure 1. Percentage of Patients Who Received ACEIs/ARBs, Beta-Blockers, and/or Cardiology Consultation After the Start of Chemotherapy
Open bars on the bar graph represent the percentage of patients with left ventricular ejection fraction (LVEF) <55% who received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs), beta-blockers, and/or cardiology consultation. Blue bars represent the percentage of patients with a symptomatic LVEF <55%, and red bars represent the percentage of patients with an asymptomatic LVEF <55% who received ACEI/ARBs, beta-blockers, and/or cardiology consultation.

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