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 and La Gerche, Andre 2021, Traditional markers of cardiac toxicity fail to detect marked reductions in cardiorespiratory fitness among cancer patients undergoing anti-cancer treatment, European heart journal cardiovascular imaging, vol. 22, no. 4, pp. 451-458, doi: 10.1093/ehjci/jeaa421.

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Title Traditional markers of cardiac toxicity fail to detect marked reductions in cardiorespiratory fitness among cancer patients undergoing anti-cancer treatment
Author(s) Howden, Erin J
Foulkes, Steve
Dillon, Hayley T
Bigaran, Ashley
Wright, Leah
Janssens, Kristel
Comie, Prue
Costello, Benedict
La Gerche, Andre
Journal name European heart journal cardiovascular imaging
Volume number 22
Issue number 4
Start page 451
End page 458
Total pages 8
Publisher Oxford University Press
Place of publication Oxford, Eng.
Publication date 2021-04
ISSN 2047-2404
2047-2412
Keyword(s) oncology
haematology
cardiotoxicity
heart failure
chemotherapy
echocardiography
biomarkers
Cardiac & Cardiovascular Systems
Cardiovascular System & Cardiology
Life Sciences & Biomedicine
Radiology, Nuclear Medicine & Medical Imaging
Science & Technology
Summary 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.
Language eng
DOI 10.1093/ehjci/jeaa421
Indigenous content off
HERDC Research category C1 Refereed article in a scholarly journal
Persistent URL http://hdl.handle.net/10536/DRO/DU:30150029

Document type: Journal Article
Collections: Faculty of Health
School of Exercise and Nutrition Sciences
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