Introduction Chemotherapy-induced cardiomyopathy has been increasingly recognised as patients are living longer with more effective treatments for their malignancies. Anthracyclines are known to cause left ventricular (LV) dysfunction. While heart failure medications are frequently used, some patients may need consideration for device-based therapies such as cardiac resynchronisation therapy (CRT). However, the role of CRT in anthracycline-induced cardiomyopathy (AIC) is not well understood. Methods We performed a retrospective review of all patients undergoing CRT implantation at our centre from 2003 to 2019 with a diagnosis of AIC. The LV remodelling and survival outcomes of this population were obtained and then compared with consecutive patients with other aetiologies of non-ischaemic cardiomyopathy (NICM). Results A total of 34 patients underwent CRT implantation with a diagnosis of AIC with a mean age of 60.5±12.7 years, left ventricular ejection fraction (LVEF) of 21.7%±7.4%, and 11.3±7.5 years and 10.2±7.4 years from cancer diagnosis and last anthracycline exposure, respectively. At 9.6±8.1 months after CRT implantation, there was an increase of LVEF from 21.8%±7.6% to 30.4%±13.0% (p<0.001). Patients whose LVEF increased by at least 10% post-CRT implant (42.5% of cohort) survived significantly longer than patients who failed to improve their LVEF by that amount (p=0.01). A propensity matched analysis between patients with AIC and 369 consecutive patients with other aetiologies of NICM who underwent CRT implantation during the same period revealed no significant differences in improvement in LVEF or long-term survival. Conclusions Patients with AIC undergo LV remodelling with CRT at rates similar to other aetiologies of NICM. Furthermore, AIC post-CRT responders have a favourable long-term mortality compared with non-responders. Data are available upon reasonable request from the institution and the senior author.

中文翻译：

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蒽环类药物所致心肌病的心脏再同步化治疗

引言 化疗引起的心肌病越来越受到人们的认可，因为患者的寿命更长，并且对其恶性肿瘤进行了更有效的治疗。已知蒽环类药物会导致左心室 (LV) 功能障碍。虽然经常使用心力衰竭药物，但一些患者可能需要考虑基于设备的治疗，例如心脏再同步治疗 (CRT)。然而，CRT 在蒽环类药物诱导的心肌病 (AIC) 中的作用尚不清楚。方法 我们对 2003 年至 2019 年在我们中心接受 CRT 植入的所有诊断为 AIC 的患者进行了回顾性研究。获得该人群的 LV 重塑和生存结果，然后与其他非缺血性心肌病 (NICM) 病因的连续患者进行比较。结果 共 34 例患者接受 CRT 植入，诊断为 AIC，平均年龄 60.5±12.7 岁，左心室射血分数（LVEF）为 21.7%±7.4%，患癌分别为 11.3±7.5 岁和 10.2±7.4 岁诊断和最后一次蒽环类药物暴露。在 CRT 植入后 9.6±8.1 个月，LVEF 从 21.8%±7.6% 增加到 30.4%±13.0% (p<0.001)。CRT 植入后 LVEF 增加至少 10% 的患者（队列中的 42.5%）的存活时间明显长于未能将 LVEF 改善该数量的患者（p=0.01）。AIC 患者和 369 名在同一时期接受 CRT 植入的其他 NICM 病因的连续患者之间的倾向匹配分析显示，在 LVEF 或长期生存率的改善方面没有显着差异。结论 AIC 患者接受 CRT 的 LV 重塑率与其他 NICM 病因相似。此外，与无反应者相比，CRT 后 AIC 反应者的长期死亡率更高。数据可根据机构和资深作者的合理要求提供。