Abstract 14563: Improved Outcomes in Patients With Anthracycline-Induced Cardiomyopathy Undergoing Left Ventricular Assist Devices: 10-Year Longitudinal INTERMACS Study

Abstract

Introduction: Anthracycline-induced cardiomyopathy (AC-CM) presenting as end-stage heart failure may require mechanical circulatory support. Hypothesis: We hypothesize that there is no difference in outcomes after LVAD placement in those with AC-CM compared to other forms of cardiomyopathy. Methods: Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) dataset spanning from 2008 to 2017 was utilized to identify adult AC-CM patients undergoing continuous flow LVAD implantation excluding those who required concomitant cardiac procedures and right ventricular support (RVS). AC-CM patients were compared to those undergoing LVAD placement due to idiopathic dilated cardiomyopathy (IDM) and ischemic cardiomyopathy (ICM). Primary outcome of overall mortality was studied using Cox-proportional hazards model. Secondary outcomes of first infection, ischemic stroke, major bleeding and subsequent RVS were evaluated using Fine-Gray competing risk model accounting for appropriate competing risks. Subgroup analysis based on gender, race, ethnicity, and use of pre-transplant goal directed medical therapy (GDMT) for systolic heart failure was performed. Result: Overall, 248 AC-CM patients underwent continuous flow LVADs in the 10-year period. At 12-months, 85.1% of AC-CM, 86.0% of IDM and 80.2% of ICM patients were alive (log-rank P < 0.001). There was no difference in mortality compared to ICM and IDM ( P > 0.05). However, pre-LVAD GDMT improved mortality in only the AC-CM cohort when compared to those patients who were not on GDMT (adjusted hazards ratio (HR): 0.44; confidence interval (CI): 0.19 - 0.99). AC-CM patients had a higher risk of major bleeding compared to IDM patients (HR: 1.23; CI: 1.01 - 1.50). AC-CM patients had lower risk of stroke compared to ICM patients (HR: 0.31; CI: 0.15 - 0.62). There was no difference in the three subtypes of cardiomyopathy in hazards of first infection or subsequent RVS. Conclusion: Survival rates are similar in AC-CM, ICM and IDM patients who received continuous flow LVAD therapy in the contemporary era. There is improved mortality benefit in AC-CM patients who are on GDMT before LVAD. Further research into bleeding and stroke related disparities is warranted.