Reply Enalapril and Carvedilol for Preventing Chemotherapy-Induced Left Ventricular Systolic Dysfunction in Patients With Malignant Hemopathies

We thank Dr. Golwala and Dr. Spallarossa and colleagues for their interest in our study. Both ask about the lack of association found in our study (1) between troponin elevation and benefit from pharmacological intervention. The value of troponins to predict left ventricular systolic dysfunction (LVSD) has been reported with anthracyclines but not with other drugs (2). However, we do not believe that our results are contradictory to those of Cardinale et al. (3); differences in the patient population, intensity and type of chemotherapy, and protocol design of both studies may account for their different results. Cardinale et al. included only patients with positive troponin levels 1 month after treatment, selecting a population at a particularly high risk for developing a marked drop in left ventricular ejection fraction (LVEF) (43% in their control group), whereas we enrolled all incoming patients. In our study, 10 of the 11 patients with positive troponin levels had acute leukemia, a subgroup of patients that received anthracyclines and a more intense chemotherapy regimen and in whom we observed a marked effect of the intervention. Large randomized trials are needed to determine whether a strategy of primordial prevention with cardioprotective drugs to all patients is more effective than a troponin-directed strategy.
Source: Journal of the American College of Cardiology: Cardiovascular Interventions - Category: Cardiology Source Type: research