Cardiac dysfunction in cancer survivors unmasked during exercise

authored by

Maria C. Kearney, Eve Gallop-Evans, John R. Cockcroft, Eric J. Stöhr, Eveline Lee, Karianne Backx, Mark Haykowsky, Zaheer Yousef, Rob Shave

Abstract

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.

Organisation(s)

Sports and Health

External Organisation(s)

Cardiff Metropolitan University
Velindre Cancer Centre
Cardiff University School of Medicine
University Hospital of Wales
University of Texas at Arlington

Type

Article

Journal

European Journal of Clinical Investigation

Volume

47

Pages

213-220

No. of pages

8

ISSN

0014-2972

Publication date

03.2017

Publication status

Published

Peer reviewed

Yes

ASJC Scopus subject areas

Biochemistry, Clinical Biochemistry

Sustainable Development Goals

SDG 3 - Good Health and Well-being

Electronic version(s)

https://doi.org/10.1111/eci.12720 (Access: Closed)
http://hdl.handle.net/10369/8275 (Access: Open)