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Title: Optimisation of Heart Failure Treatment Recommended in Patients With Chemotherapy-Related Heart Failure: Presented at HFSA
URL: http://www.pslgroup.com/dg/22D73E.htm
Doctor's Guide
September 24, 2008

By Jill Stein

TORONTO -- September 24, 2008 -- Optimal heart failure therapy may improve left-ventricular ejection fraction (LVEF) in a substantial number of cancer patients with chemotherapy-related cardiotoxicity, investigators reported here at the Heart Failure Society of America (HFSA) 12th Annual Scientific Meeting.

Daniel Lenihan, MD, University of Texas M.D. Anderson Cancer Center, Houston, Texas, and colleagues investigated 97 patients with chemotherapy-related heart failure.

"As cancer therapy becomes more successful, the potential for cardiac complications related to cancer therapy has been increasingly recognised," Dr. Lenihan observed in a presentation on September 23. "In addition, controlling potential longer-term side effects is now a priority for survivors of a variety of treatable cancers."

While heart disease, and specifically heart failure, is one of the most important treatment-limiting effects of cancer therapy, only limited data about the effects of aggressive heart-failure therapy on patient outcomes is available, he added.

Upon initial presentation, 55 (57%) patients in this series had typical physical findings of heart failure (venous distension, lung crackles, S3 gallop, or oedema) and 64 (66%) had New York Heart Association Class II symptoms or worse.

Levels of B-type natriuretic peptide were measured in 64 (66%) patients at diagnosis, with a markedly elevated mean value of 1,104pg/mL.

The diagnosis of heart failure was either definitely or probably associated with chemotherapy in 66 (68%) patients, while there was a possible association in 29 (30%) patients.

All patients had at least a 10% decrease in LVEF during chemotherapy, and 14 (14%) developed heart failure with an overall normal LVEF. Medical therapy for heart failure included beta-blockers in 89% of patients, angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers in 67 %, diuretics in 61%, and various other adjunct therapies.

Patients were optimised on medical therapy for heart failure, and 55% had an LVEF improvement of more than 10 ejection-fraction units.

Overall, the findings demonstrate that optimal heart failure therapy is likely to benefit a "sizable proportion" of patients with chemotherapy-related heart failure, Dr. Lenihan concluded.


[Presentation title: Clinical Characteristics and Improvement in Systolic Dysfunction in Patients With Chemotherapy-Related Heart Failure. Abstract 371]

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