Dr. Varun Sundaram MD

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Advanced Heart Failure Therapies for
Chemotherapy-Induced Cardiomyopathy

• Dr. Varun Sundaram MD
• On behalf of Dr. Guilherme H Oliveira, MD
• Associate Professor of Medicine
• Chief, Section of Heart Failure Cardiac
  Transplantation
• Director, UH Seidman Onco-Cardiology
  Program Harrington Heart Vascular Institute
• University Hospitals Case Medical Center
• Case Western Reserve University

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Outline

• Scope of the problem
• Distinguishing characteristics of CCMP patients
  with advanced heart failure in the waiting list
• Right ventricular involvement in CCMP
• LVADS in CCMP

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Number of Cancer Survivors in the US
1 in 23 Americans is a cancer Survivor today
AACR Cancer Progress Report 2013
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Prevalence of CCMP within Advanced Heart
Failure Population
1000-5000 patients with CCMP
1. Miller LW et al. J Am Coll Cardiol Vol.
61,2013 2. Oliveira GH et al. J Am Coll Cardiol
Vol 62, 2014 3. Oliveira GH et al. J Heart Lung
Transplant, 2012 4. Oliveira GH et al. Circ Heart
Fail, Vol 7 (8), 2014
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Incidence of heart
transplant for CCMP
Unpublished data
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Malignancies associated with CCMP and advanced HF
Oliveira GH et al. J Heart Lung Transplant, 2012
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Prognosis of CCMP
Felker et al. NEJM 2000
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Outline

• Scope of the problem
• Distinguishing characteristics of CCMP patients
  with advanced heart failure
• Right ventricular involvement in CCMP
• LVADS in CCMP

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Baseline Characteristics (p0.05)
Oliveira GH et al. JHLT 2012
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Different sizes between CCMP and NICMP

Oliveira GH et al. J Am Coll
Cardiol Vol 62, 2014
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Oliveira GH et al. J Am Coll Cardiol Vol 62, 2014
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Natural History of CCMP
Unpublished data
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Women are at higher risk for wait-list
mortality or deterioration
Adjusted for UNOS Status and year of listing
Unpublished data
Adjusted for UNOS Status and year of listing
Adjusted for UNOS Status and year of listing
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Unpublished data
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Unpublished data
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Outline

• Scope of the problem
• Distinguishing characteristics of CCMP patients
  with advanced heart failure in the waiting list
• Right ventricular involvement in CCMP
• LVADS in CCMP

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The RV in CCMP
Oliveira GH et al. J Heart Lung Transplant, 2012
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Oliveira GH et al. Circ Heart Fail, Vol 8, 2014
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Oliveira GH et al. J Am Coll Cardiol Vol 62, 2014
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Outline

• Scope of the problem
• Distinguishing characteristics of CCMP patients
  with advanced heart failure in the waiting list
• Right ventricular involvement in CCMP
• LVADS in CCMP

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Oliveira GH et al. Circ Heart Fail, Vol 8, 2014
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Survival of CCMP with
LVADS
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LVAD
survival CCMP vs. others
Oliveira GH et al. J Am Coll Cardiol Vol 62, 2014
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CCMP with BiVADS
Oliveira GH et al. J Am Coll Cardiol Vol 62, 2014
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Oliveira GH et al. J Am Coll Cardiol Vol 62, 2014
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Oliveira GH et al. J Am Coll Cardiol Vol 62, 2014
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• Incidence of patients with advanced heart failure
  from
• cancer therapies is increasing
• Most common malignancies associated with CCMP are
  
• breast cancer and hematologic malignancies
• CCMP is associated with more RV involvement than
• most other types of cardiomyopathies
• Patients with CCMP that require advanced heart
  failure
• therapies are predominantly female

CONCLUSIONS
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CONCLUSIONS

• LVADs are safe and effective in CCMP patients
  and survival
• is the same unless RVAD is needed

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Thank you!