Persistent impairment in cardiopulmonary fitness following breast cancer chemotherapy

Foulkes, Stephen, Howden, Erin J, Bigaran, Ashley, Janssens, Kristel, Antill, Yoland, Loi, Sherene, Claus, Piet, Haykowsky, Mark J, Daly, Robin M, Fraser, Steven F and La Gerche, Andre 2019, Persistent impairment in cardiopulmonary fitness following breast cancer chemotherapy, Medicine and science in sports and exercise, pp. 1-43, doi: 10.1249/MSS.0000000000001970.

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Title Persistent impairment in cardiopulmonary fitness following breast cancer chemotherapy
Author(s) Foulkes, Stephen
Howden, Erin J
Bigaran, Ashley
Janssens, Kristel
Antill, Yoland
Loi, Sherene
Claus, Piet
Haykowsky, Mark J
Daly, Robin MORCID iD for Daly, Robin M
Fraser, Steven FORCID iD for Fraser, Steven F
La Gerche, Andre
Journal name Medicine and science in sports and exercise
Start page 1
End page 43
Total pages 43
Publisher Wolters Kluwer
Place of publication Philadelphia, Pa.
Publication date 2019-03-01
ISSN 1530-0315
Keyword(s) Cardiotoxicity
Cardiac function
Cardiopulmonary fitness
Exercise training
Summary PURPOSE: Anthracycline chemotherapy (AC) is associated with acute reductions in cardiopulmonary fitness (VO2peak). We sought to determine whether changes in VO2peak and cardiac function persisted at 12-months post-AC completion, and whether changes in cardiac function explain the heightened long-term heart failure risk. METHODS: Women with breast cancer scheduled for AC (n=28) who participated in a non-randomized trial of exercise training (ET; n=14) or usual care (UC; n=14) during AC completed a follow-up evaluation 12-months post-AC completion (16-months from baseline). At baseline, 4-months, and 16-months, participants underwent a resting echocardiogram (left ventricular ejection fraction, LVEF; global longitudinal strain, GLS), a blood sample (troponin; b-type natriuretic peptide), a cardiopulmonary exercise test, and cardiac MRI measures of stroke volume (SV), heart rate (HR) and cardiac output (Qc) at rest, and during intense exercise. RESULTS: Seventeen women (UC: n=8; ET: n=9) completed evaluation at baseline, 4-months and 16-months. At 4-months, AC was associated with 18% and 6% reductions in VO2peak in the UC and ET groups respectively, that persisted at 16-months (UC: -16%; ET: -7%), and was not attenuated by ET (interaction, P=0.10). Exercise Qc was lower at 16-months compared to baseline and 4-months (P<0.001), which was due to a blunted augmentation of SV during exercise (P=0.032; a 14% reduction in peak SV), with no changes in HR response. There was a small reduction in resting LVEF (baseline to 4-months) and GLS (between 4-months and 16-months), and an increase in troponin (baseline to 4-months), but only exercise Qc was associated with VO2peak (R=0.47, P<0.01). CONCLUSION: Marked reductions in VO2peak persisted 12-months following anthracycline-based chemotherapy, which was associated with impaired exercise cardiac function. CLINICAL TRIAL REGISTRATION: ACTRN12616001602415.
Notes In press
Language eng
DOI 10.1249/MSS.0000000000001970
Field of Research 1106 Human Movement and Sports Sciences
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2019, American College of Sports Medicine
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Document type: Journal Article
Collections: Faculty of Health
School of Exercise and Nutrition Sciences
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