Anthracycline-related cardiomyopathy
| Risk factors, pathophysiology, prevention, management, and current research efforts . | |
|---|---|
| Main risk factor: anthracycline and anthraquinone exposure51 | The risk for cardiac dysfunction increases with anthracycline dose Cardiotoxicity conversion ratios: doxorubicin: 1 (reference), daunorubicin: 0.6, epirubicin: 0.8, idarubicin: 5, mitoxantrone: 10.5 |
| Other risk factors52-55 | Younger age at anthracycline and anthraquinone exposure Female sex Chest radiation exposure (TBI?) |
| Pathophysiology48-50 | Single cell myocytolysis → patchy myocardial necrosis → focal myocardial fibrosis → multifocal myocardial fibrosis (clinically overt congestive heart failure) Genetic predisposition |
| Clinical classification48-50 | Acute cardiotoxicity (withing weeks of anthracycline and anthraquinone exposure; impaired myocardial contractility) Early-onset chronic cardiotoxicity (<1 y after leukemia therapy completion; dilated/hypokinetic cardiomyopathy) Late-onset chronic cardiotoxicity (>1 y after leukemia therapy completion; dilated/hypokinetic cardiomyopathy) |
| Cardioprotection56,57 | Limiting anthracycline/anthraquinone cumulated dose Use of cardioprotectant drug: dexrazoxane Use of liposome-encapsulated versions of anthracyclines |
| Interventions for cardiomyopathy48-50 | Early use of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, or beta-blockers (may prevent severe contractile dysfunction and improve cardiac function) |
| Current research efforts49 | Early detection of anthracycline-related cardiomyopathy Polygenic risk scores Patient-specific hiPSC-CMs |
| Risk factors, pathophysiology, prevention, management, and current research efforts . | |
|---|---|
| Main risk factor: anthracycline and anthraquinone exposure51 | The risk for cardiac dysfunction increases with anthracycline dose Cardiotoxicity conversion ratios: doxorubicin: 1 (reference), daunorubicin: 0.6, epirubicin: 0.8, idarubicin: 5, mitoxantrone: 10.5 |
| Other risk factors52-55 | Younger age at anthracycline and anthraquinone exposure Female sex Chest radiation exposure (TBI?) |
| Pathophysiology48-50 | Single cell myocytolysis → patchy myocardial necrosis → focal myocardial fibrosis → multifocal myocardial fibrosis (clinically overt congestive heart failure) Genetic predisposition |
| Clinical classification48-50 | Acute cardiotoxicity (withing weeks of anthracycline and anthraquinone exposure; impaired myocardial contractility) Early-onset chronic cardiotoxicity (<1 y after leukemia therapy completion; dilated/hypokinetic cardiomyopathy) Late-onset chronic cardiotoxicity (>1 y after leukemia therapy completion; dilated/hypokinetic cardiomyopathy) |
| Cardioprotection56,57 | Limiting anthracycline/anthraquinone cumulated dose Use of cardioprotectant drug: dexrazoxane Use of liposome-encapsulated versions of anthracyclines |
| Interventions for cardiomyopathy48-50 | Early use of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, or beta-blockers (may prevent severe contractile dysfunction and improve cardiac function) |
| Current research efforts49 | Early detection of anthracycline-related cardiomyopathy Polygenic risk scores Patient-specific hiPSC-CMs |
hiPSC-CMs, human induced pluripotent stem cell–derived cardiomyocytes.