Effectiveness of cardiac resynchronization therapy in cancer therapy-related cardiac dysfunction: a systematic review...

Advances in cancer treatment have increased the number of survivors, making cancer therapy-related cardiac dysfunction (CTRCD) an important concern. While cardiac resynchronization therapy (CRT) is established for heart failure with reduced ejection fraction and conduction disorders, its role in CTRCD remains unclear. We conducted a meta-analysis to assess the benefit of CRT in patients with CTRCD.

We performed a literature search of studies showing CRT outcomes in the specific group of CTRCD patients. The outcomes of interest were left ventricular ejection fraction (LVEF) and LV volume improvement. A random effects meta-analysis was done to estimate 95% confidence intervals (CI).

This analysis included four studies (one prospective and three retrospective) comprising 110 patients with CTRCD, the majority (91%, n = 100) being survivors of breast cancer or lymphoma/leukemia. Baseline LVEF ranged from 18.6% ± 7.6% to 28.5% ± 3.8% (mean 24% ± 7%). After a mean follow-up of 9 ± 5 months, LVEF increased by 9.95% (95% CI 7.79-12.11) and end-systolic volume decreased by 39.17 mL (95% CI 24.99-53.35). Three studies included a control group of patients with other forms of non-ischemic cardiomyopathy who underwent CRT implantation, showing no significant difference in LVEF improvement between the two groups.

This meta-analysis suggests that CRT improves LVEF and LV volumes in selected patients with CTRCD, with a magnitude of reverse remodeling that appears similar to that observed in other etiologies of non-ischemic cardiomyopathy. However, the evidence is limited to small observational studies, so conclusions about clinical outcomes remain uncertain. Thus, CRT may be considered in cancer patients who meet standard criteria for CRT implantation, but the decision should be individualized and guided by multidisciplinary assessment, cancer prognosis, and competing clinical risks.