Usefulness of cardiac resynchronization therapy in the management of Doxorubicin-induced cardiomyopathy

Doxorubicin is a widely used antineoplastic agent that may cause irreversible dilated cardiomyopathy. Doxorubicin-induced cardiomyopathy (DIC) can occur several years after exposure and carries a poor prognosis. Although cardiac resynchronization therapy (CRT) is a useful intervention in end-stage heart failure unresponsive to optimal medical therapies, its efficacy in DIC remains unknown. Four consecutive patients receiving CRT for DIC were evaluated before and after CRT. CRT resulted in improvements in the mean left ventricular ejection fraction at 1 month from 21 +/- 4.7% to 34 +/- 5% (p = 0.03) and at 6 months (to 46 +/- 7.5%, p = 0.01). CRT-induced reverse remodeling was observed, with a mean reduction in left ventricular internal diameter at end-diastole from 54.75 +/- 3.7 to 52.5 +/- 1.9 min at 1 month (p = 0.06) and further to 47 +/- 2.3 mm at 6 months (p = 0.03). All patients experienced reductions in heart failure symptoms and improvements in New York Heart Association functional class (p < 0.05). The impact of CRT was sustained over a follow-up of 18.5 +/- 3.5 months. In conclusion, this study suggests that patients with DIC, refractory to optimal pharmacologic therapy and meeting criteria for resynchronization device implantation, may achieve sustained benefit from CRT. (c) 2008 Elsevier Inc. All rights reserved.