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 |
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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 |
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