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Traditional markers of cardiac toxicity fail to detect marked reductions in cardiorespiratory fitness among cancer patients undergoing anti-cancer treatment
Howden, Erin J. Foulkes, Steve Dillon, Hayley T. Bigaran, Ashley Wright, Leah Janssens, Kristel Comie, Prue Costello, Benedict La Gerche, André
Howden, Erin J.
Foulkes, Steve
Dillon, Hayley T.
Bigaran, Ashley
Wright, Leah
Janssens, Kristel
Comie, Prue
Costello, Benedict
La Gerche, André
Abstract
Aims
Left ventricular ejection fraction (LVEF) is standard of care for evaluating chemotherapy-associated cardiotoxicity, although global longitudinal strain (GLS) offers advantages. However, neither change in LVEF or GLS has been associated with short-term symptoms, functional capacity, or long-term heart failure (HF) risk. We sought to determine whether an integrative measure of cardiovascular function (VO2peak) that is strongly associated with HF risk would be more sensitive to cardiac damage induced by cancer treatment than LVEF, GLS, or cardiac biomarkers.
Methods and results
Patients (n = 206, 53 ± 13 years, 35% male) scheduled to commence anti-cancer treatment completed assessment prior to, and within 6 months after therapy. Changes in echocardiographic measures of LV function (LVEF, GLS), cardiac biomarkers (troponin and BNP), and cardiorespiratory fitness (VO2peak) were measured. LV function was normal prior to treatment (LVEF 61 ± 5%; GLS −19.4 ± 2.1), but VO2peak was only 88 ± 26% of age-predicted. After treatment, VO2peak was reduced by 7 ± 15% (equivalent of 7 years normal ageing, P < 0.0001) and the rates of functional disability (defined as VO2peak ≤ 18 mL/min/kg) almost doubled (15% vs. 26%, P = 0.016). In contrast, small, reductions in LVEF (59 ± 5% vs. 58 ± 5%, P = 0.03) and GLS (−19.4 ± 2.1 vs. −18.9 ± 2.2, P = 0.002) and an increase in troponin levels (4.0 ± 6.9 vs. 26.4 ± 26.2 ng/mL, P < 0.0001) were observed.
Conclusion
Anti-cancer treatment is associated with marked reductions in functional capacity that occur independent of reductions in LVEF and GLS. The assessment of VO2peak prior to, and following treatment may be a more sensitive means of identifying patients at increased risk of HF.
Keywords
oncology, haematology, cardiotoxicity, heart failure, chemotherapy, echocardiography, biomarkers
Date
2021
Type
Journal article
Journal
European Heart Journal: Cardiovascular Imaging
Book
Volume
22
Issue
4
Page Range
451-458
Article Number
ACU Department
School of Behavioural and Health Sciences
Faculty of Health Sciences
Centre for Exercise and Nutrition
Faculty of Health Sciences
Centre for Exercise and Nutrition
Relation URI
Source URL
Event URL
Open Access Status
License
All rights reserved
File Access
Controlled