Abstract 4142220: Recovery of Anthracycline-Induced Cardiomyopathy- A Contemporary Cohort Study

Background: There are limited data regarding left ventricular ejection fraction (LVEF) recovery rates among patients with anthracycline-induced cardiomyopathy (AIC). Aims: To assess the rate of LVEF recovery and its predictors in a contemporary and heterogenous cohort of patients with AIC. Methods: A retrospective cohort study of adult patients with new onset cardiomyopathy determined to be secondary to anthracyclines after a comprehensive work-up for potential etiologies within Massachusetts General Brigham between 2010 and 2023. LVEF recovery was defined as an absolute LVEF increase of ≥10% from LVEF at detection of AIC to a final LVEF ≥50%. Time to LVEF recovery within the first 3 years post-diagnosis was assessed using Cox proportional hazards regression analysis with all-cause death/mechanical circulatory support/heart transplant as competing risks based on the Fine-Gray method. Non-fatal cardiovascular (CV) events included acute decompensated heart failure, acute coronary syndrome and malignant arrhythmias requiring admission. Results: The cohort included 167 patients with AIC. The median age at anthracycline exposure was 60 (Q1, Q3: 48, 69) years, 53% (n=88) were females and majority had lymphoma (n=92, 55%) and breast cancer (n=39, 23%). The median time from first anthracycline exposure to detection of AIC was 631 (Q1, Q3: 219, 3569) days and median LVEF was 38 (Q1, Q3: 29, 45) %. A total of 42% (n=70) were managed by dedicated cardio-oncologists and neurohormonal therapy was prescribed in 86% (n=144). LVEF recovered in 38% (n=63) at a median time of 349 (Q1:Q3: 137, 691) days from AIC detection. Statin use was associated with a higher likelihood of recovery (HR=2.162, 95%CI:1.207-3.875, p=0.009), while age>60 at time of anthracycline exposure, non-white race, longer duration between anthracycline exposure and detection of AIC, increased LV end-diastolic diameter, and lymphoma vs. other cancers had lower adjusted odds of LVEF recovery. Patients with recovered LVEF were less likely to experience CV events during follow-up (HR=0.455; CI 0.22-0.95, p=0.036). LVEF recovery, as a time-dependent variable, was not associated with all-cause or cardiovascular death. Conclusion: In a contemporary cohort of patients with AIC, 38% experienced LVEF recovery and lack of recovery was associated with a higher burden of CV events requiring admission. Routine screening for AIC may improve the likelihood of recovery and improve outcomes.