한빛사논문
Hyukjin Park, MD,a,* Nuri Lee, MD, a,* Cho Hee Hwang, MPH,b Sang-Geon Cho, MD,c Ga Hui Choi, MD,d Jae Yeong Cho, MD, d,e Hyun Ju Yoon, MD,d,e Kye Hun Kim, MD,d,e Youngkeun Ahn, MDd,e
From the aDepartment of Cardiology, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea;
bRegional Cardiocerebrovascular Center, Chonnam National University Hospital, Gwangju, Republic of Korea;
cDepartment of Nuclear Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea;
dDepartment of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea; and the
eDepartment of Cardiovascular Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea.
*Drs Park and Lee contributed equally to this work and are co-first authors.
ADDRESS FOR CORRESPONDENCE: Dr Hyun Ju Yoon
Abstract
Background
The long-term prognosis after the discontinuation of cardioprotective therapy (CPT) in patients with cancer therapeutics–related cardiac dysfunction (CTRCD) that has shown improvement remains unclear.
Objectives
This study aims to assess the prognosis after CPT withdrawal in patients exhibiting improved CTRCD.
Methods
In this retrospective analysis of a single-center prospective cohort study, patients with improved CTRCD, defined as an increase in left ventricular ejection fraction (LVEF) ≥10 percentage points from the time of CTRCD diagnosis, were included. We analyzed their clinical outcomes, which included hospitalization for heart failure or a decrease in LVEF ≥10 percentage points within 2 years after CTRCD improvement, alongside echocardiographic changes.
Results
The cohort comprised 134 patients with improved CTRCD. The median follow-up duration after CTRCD diagnosis was 368.3 days (Q1-Q3: 160-536 days). After improvement, 90 patients continued CPT (continued group [CG]) and 44 withdrew CPT (withdrawn group [WG]). Among patients whose baseline LVEF at CTRCD diagnosis ranged from 45% to 55%, the final mean LVEF was comparable between both groups (CG: 64.9% ± 4.4% vs WG: 62.9% ± 4.2%; P = 0.059). However, for patients with a baseline LVEF <45%, the final mean LVEF was significantly lower in the WG (CG: 53.3% ± 6.4% vs WG: 48.2% ± 6.9%; P < 0.001). The occurrence of composite major clinical events was notably higher in the WG (HR: 3.06; 95% CI: 1.51-7.73; P = 0.002).
Conclusions
Patients who withdrew CPT after demonstrating improvement in CTRCD experienced worse clinical outcomes. Notably, a significant decrease in LVEF was observed after CPT withdrawal in patients with a baseline LVEF <45%.
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