- Design
- Systematic review and meta-analysis of four observational studies
- Population
- 110 patients with cancer therapy-related cardiac dysfunction and mean LVEF 24%
- Primary outcome
- Change in LVEF and LV volumes after CRT
- Effect
- LVEF +9.95 points (95% CI 7.79 to 12.11); LVESV −39.2 mL (24.99 to 53.35)
This meta-analysis pooled four studies, one prospective and three retrospective, of cardiac resynchronisation therapy in 110 patients with cancer therapy-related cardiac dysfunction and a mean ejection fraction of 24%.
After about nine months, ejection fraction rose by about 10 percentage points and end-systolic volume fell by about 39 mL. In three studies with a non-ischaemic comparison group, the improvement was similar.
The evidence is thin and the outcome is imaging, not survival. It supports applying the usual CRT criteria to cancer survivors rather than treating their cardiomyopathy as a special case.
- Most patients had survived breast cancer, lymphoma or leukaemia, often after anthracyclines.
- Mean ejection fraction rose about 10 points over about nine months.
- End-systolic volume fell by about 39 mL.
- The response was similar to CRT in other non-ischaemic cardiomyopathies.
- Weigh cancer prognosis and competing risks before implanting.
Why it matters
Cancer survivors with cardiomyopathy are sometimes not offered device therapy, and the remodelling response here looked like that of other non-ischaemic causes.
Don't overread it
Four small mostly retrospective studies measured ejection fraction, not survival or hospitalisation.
The statistics, in plain English
The confidence intervals are narrow but rest on 110 patients in studies without randomisation, so selection bias is likely: people chosen for CRT may already have been the healthier ones.
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