TY - JOUR

T1 - Cardiac dysfunction in cancer survivors unmasked during exercise

AU - Kearney, Maria C.

AU - Gallop-Evans, Eve

AU - Cockcroft, John R.

AU - Stöhr, Eric J.

AU - Lee, Eveline

AU - Backx, Karianne

AU - Haykowsky, Mark

AU - Yousef, Zaheer

AU - Shave, Rob

PY - 2017/3

Y1 - 2017/3

N2 - Background: The cardiac dysfunction associated with anthracycline-based chemotherapy cancer treatment can exist subclinically for decades before overt presentation. Stress echocardiography, the measurement of left ventricular (LV) deformation and arterial haemodynamic evaluation, has separately been used to identify subclinical cardiovascular (CV) dysfunction in several patient groups including those with hypertension and diabetes. The purpose of the present cross-sectional study was to determine whether the combination of these techniques could be used to improve the characterisation of subclinical CV dysfunction in long-term cancer survivors previously treated with anthracyclines. Materials and methods: Thirteen long-term cancer survivors (36 ± 10 years) with prior anthracycline exposure (11 ± 8 years posttreatment) and 13 age-matched controls were recruited. Left ventricular structure, function and deformation were assessed using echocardiography. Augmentation index was used to quantify arterial haemodynamic load and was measured using applanation tonometry. Measurements were taken at rest and during two stages of low-intensity incremental cycling. Results: At rest, both groups had comparable global LV systolic, diastolic and arterial function (all P > 0·05); however, longitudinal deformation was significantly lower in cancer survivors (−18 ± 2 vs. −20 ± 2, P < 0·05). During exercise, this difference between groups persisted and further differences were uncovered with significantly lower apical circumferential deformation in the cancer survivors (−24 ± 5 vs. −29 ± 5, −29 ± 5 vs. 35 ± 8 for first and second stage of exercise respectively, both P < 0·05). Conclusion: In contrast to resting echocardiography, the measurement of LV deformation at rest and during exercise provides a more comprehensive characterisation of subclinical LV dysfunction. Larger studies are required to determine the clinical relevance of these preliminary findings.

AB - Background: The cardiac dysfunction associated with anthracycline-based chemotherapy cancer treatment can exist subclinically for decades before overt presentation. Stress echocardiography, the measurement of left ventricular (LV) deformation and arterial haemodynamic evaluation, has separately been used to identify subclinical cardiovascular (CV) dysfunction in several patient groups including those with hypertension and diabetes. The purpose of the present cross-sectional study was to determine whether the combination of these techniques could be used to improve the characterisation of subclinical CV dysfunction in long-term cancer survivors previously treated with anthracyclines. Materials and methods: Thirteen long-term cancer survivors (36 ± 10 years) with prior anthracycline exposure (11 ± 8 years posttreatment) and 13 age-matched controls were recruited. Left ventricular structure, function and deformation were assessed using echocardiography. Augmentation index was used to quantify arterial haemodynamic load and was measured using applanation tonometry. Measurements were taken at rest and during two stages of low-intensity incremental cycling. Results: At rest, both groups had comparable global LV systolic, diastolic and arterial function (all P > 0·05); however, longitudinal deformation was significantly lower in cancer survivors (−18 ± 2 vs. −20 ± 2, P < 0·05). During exercise, this difference between groups persisted and further differences were uncovered with significantly lower apical circumferential deformation in the cancer survivors (−24 ± 5 vs. −29 ± 5, −29 ± 5 vs. 35 ± 8 for first and second stage of exercise respectively, both P < 0·05). Conclusion: In contrast to resting echocardiography, the measurement of LV deformation at rest and during exercise provides a more comprehensive characterisation of subclinical LV dysfunction. Larger studies are required to determine the clinical relevance of these preliminary findings.

KW - Anthracyclines

KW - arterial haemodynamics

KW - cardiac deformation

KW - exercise echocardiography

UR - http://www.scopus.com/inward/record.url?scp=85011022985&partnerID=8YFLogxK

U2 - 10.1111/eci.12720

DO - 10.1111/eci.12720

M3 - Article

C2 - 28036108

AN - SCOPUS:85011022985

VL - 47

SP - 213

EP - 220

JO - European Journal of Clinical Investigation

JF - European Journal of Clinical Investigation

SN - 0014-2972

IS - 3

T2 - 19th Annual Congress of the European College of Sport Science

Y2 - 2 July 2014 through 5 July 2014

ER -