Anthracycline-Induced Cardiotoxicity

TO THE EDITOR:

Shan and colleagues [1] provided a thorough, insightful, and well-balanced review of anthracycline cardiomyopathy. However, the discussion of the clinical significance of late-onset cardiotoxicity presented some confusing information that needs to be clarified. The authors stated that “new-onset symptomatic ventricular dysfunction was not seen until 12 to 14 years after treatment in the study by Lipshultz and coworkers.” However, the symptomatic patients reported by Lipshultz and colleagues actually had “recurrent heart failure 3.7 to 10.3 years after completing doxorubicin treatment, and … [n]o patient had late heart failure as a new event” [2]. In fact, the patients Shan and colleagues cited as having “new-onset symptomatic ventricular dysfunction” were described in a study my colleagues and I conducted; in this study, the four patients with de novo late symptoms had been treated 12 to 18 years earlier [3]. Although most patients we described had been followed for less than 10 years after completion of chemotherapy, our cohort contained 56 patients who were followed for more than 10 years (≤ 20 years after chemotherapy). The incidence of systolic ventricular dysfunction in this subset was as high as 38%, as can be seen in our figure (Shan and colleagues' Figure 3).