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 association with cardiovascular outcomes in a contemporary and diverse AIC cohort.

Methods: This retrospective study analyzed patients diagnosed with AIC from 2010-2023 at two 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 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 using Cox regression analysis with LVEF recovery as a time-dependent factor.

Results: Among 167 patients with AIC (median age 67 (Q1, Q3: 53, 74) years, 53% female), 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.