Improving survival of chemotherapy-induced cardiomyopathy in the modern heart failure therapy era
Bibliographic record
Abstract
Background: Chemotherapy-induced cardiomyopathy (CI-CM) is the most frequent complication of cytotoxic drugs cardiotoxicity and portends a poor prognosis: old studies on small populations, mainly treated with digoxin and diuretics, reported a 2-year mortality rate of about 60%. Recent data, however, show a fundamental role of an early treatment with the modern heart failure (HF) therapy as a determinant of recovery from CI-CM. Aim: To demonstrate the actual improving in survival of a cohort of CI-CM pts followed at our Center in the last two decades. Methods: From 1990 to 2012 we enrolled 62 consecutive pts (32,3% M, age 49±14 y) with CI-CM. Follow up was 70±62 months. At baseline mean left ventricular (LV) ejection fraction (EF) was 39.5±10%, LV end diastolic diameter index 32.1±5 mm/m2, NYHA class 2.6±1.2. Hypertension was present in 15%, diabetes in 7% and hypercholesterolemia in 10% of pts; 10% were smokers; 64% received chemotherapy due to non-Hodgkin's lymphoma, 12% for Hodgkin's disease, 10% for breast cancer while a minority of pts were treated because of leukemia, osteosarcoma, hepatocellular carcinoma and glioblastoma; 23% had a history of previous antineoplastic treatment for the same or other types of cancer; 41% received mediastinum radiotherapy (RT); 63% showed symptoms of HF. Two or more antineoplastic treatment/RT-related complications, beyond LV dilatation/dysfunction, were evident in 21% of pts. Mean time from last antineoplastic treatment dose and CI-CM diagnosis was 39±64 months. A late-onset cardiotoxicity was reported in the majority of pts with LV dilatation/dysfunction occurring even after 23 years. At the end of follow up 64,5% of pts were receiving ACE-inhibitors, 18% ARBs and 90% betablockers (BB): the mean dose was 67%, 75% and 39% of the HF guidelines recommended dosage, respectively. Mineral corticoid receptor antagonists (MRA) were administered in 45% of pts; 76% received ACEI/ARBs plus BB and 42% of them were also on MRA. Results: The combined end-point of all cause death/heart transplantation was reached in 25 pts (40,3%): 23.8% of deaths were due to refractory HF, 14.3% were non cardiac/cancer-related and 61.9% non cardiac/possibly cancer-related. Overall survival was 72,6% at 5 years, 47,7% at 10 years. Conclusions: Our data show an improvement in survival of CI-CM pts with respect to data available in current literature. This finding presumably reflects the impact of evidence-based treatment of HF over the years, confirming the relevance of a widespread use of such therapies in early phases of cardiotoxicity related LV dysfunction.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".