Objectives The purpose of this study was to evaluate the clinical relevance of anthracycline-induced cardiomyopathy
(AC-CMP) and its response to heart failure (HF) therapy.
Background The natural history of AC-CMP, as well as its response to modern HF therapy, remains poorly defined. Hence,
evidence-based recommendations for management of this form of cardiomyopathy are still lacking.
Methods We included in the study 201 consecutive patients with a left ventricular ejection fraction (LVEF)
45% due to
AC-CMP. Enalapril and, when possible, carvedilol were promptly initiated after detection of LVEF impairment.
LVEF was measured at enrollment, every month for the first 3 months, every 3 months during the first 2 following
years, and every 6 months afterward (mean follow-up 36
27 months). Patients were considered responders,
partial responders, or nonresponders according to complete, partial, or no recovery in LVEF, respectively.
Major adverse cardiac events during follow-up were also evaluated.
Results Eighty-five patients (42%) were responders; 26 patients (13%) were partial responders, and 90 patients (45%)
were nonresponders. The percentage of responders progressively decreased as the time from the end of chemotherapy
to the start of HF treatment increased; no complete recovery of LVEF was observed after 6 months. Responders
showed a lower rate of cumulative cardiac events than partial and nonresponders (5%, 31%, and 29%,
respectively; p  0.001).
Conclusions In cancer patients developing AC-CMP, LVEF recovery and cardiac event reduction may be achieved when cardiac
dysfunction is detected early and a modern HF treatment is promptly initiated. (J Am Coll Cardiol 2010;
55:213–20) © 2010 by the American College of Cardiology Foundation