Persistent Impairment in Cardiopulmonary Fitness after Breast Cancer Chemotherapy

Autor: Ashley Bigaran, Andre La Gerche, Stephen Foulkes, Steve F. Fraser, Mark J. Haykowsky, Erin J. Howden, Sherene Loi, K. Janssens, Piet Claus, Yoland Antill, Robin M. Daly
Rok vydání: 2019
Předmět:
Cardiac function curve
medicine.medical_specialty
Cardiac output
cardiotoxicity
Antineoplastic Agents
Breast Neoplasms
Physical Therapy
Sports Therapy and Rehabilitation
Hemoglobins
03 medical and health sciences
Oxygen Consumption
0302 clinical medicine
Heart Rate
Risk Factors
Internal medicine
Natriuretic Peptide
Brain
Heart rate
medicine
Humans
Anthracyclines
Orthopedics and Sports Medicine
Cardiac Output
Aged
Exercise Tolerance
Ejection fraction
biology
business.industry
Troponin I
Stroke Volume
Cardiorespiratory fitness
030229 sport sciences
Stroke volume
Middle Aged
medicine.disease
Magnetic Resonance Imaging
Troponin
Exercise Therapy
Cardiorespiratory Fitness
Echocardiography
Heart failure
biology.protein
Cardiology
Female
cardiac function
cardiopulmonary fitness
business
exercise training
Zdroj: Medicine & Science in Sports & Exercise. 51:1573-1581
ISSN: 1530-0315
0195-9131
1261-6001
Popis: PURPOSE: Anthracycline chemotherapy (AC) is associated with acute reductions in cardiopulmonary fitness (V˙O2peak). We sought to determine whether changes in V˙O2peak 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 nonrandomized 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; global longitudinal strain), a blood sample (troponin; B-type natriuretic peptide), a cardiopulmonary exercise test, and cardiac MRI measures of stroke volume (SV), heart rate, 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 V˙O2peak in the UC and ET groups, respectively, which 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 with 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 heart rate response. There was a small reduction in resting left ventricular ejection fraction (baseline to 4 months) and global longitudinal strain (between 4 and 16 months) and an increase in troponin (baseline to 4 months), but only exercise Qc was associated with V˙O2peak (R = 0.47, P < 0.01). CONCLUSION: Marked reductions in V˙O2peak persisted 12 months after anthracycline-based chemotherapy, which was associated with impaired exercise cardiac function. CLINICAL TRIAL REGISTRATION: ACTRN12616001602415.
Databáze: OpenAIRE
Externí odkaz: