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Persistent Impairment in Cardiopulmonary Fitness after Breast Cancer Chemotherapy

FOULKES, STEPHEN J.1,2; HOWDEN, ERIN J.1; BIGARAN, ASHLEY1,3; JANSSENS, KRISTEL1; ANTILL, YOLAND4; LOI, SHERENE5; CLAUS, PIET6; HAYKOWSKY, MARK J.1,7; DALY, ROBIN M.2; FRASER, STEVE F.2; LA GERCHE, ANDRE1,8

Medicine & Science in Sports & Exercise: August 2019 - Volume 51 - Issue 8 - p 1573–1581
doi: 10.1249/MSS.0000000000001970
CLINICAL SCIENCES
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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 (R2 = 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.

1Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne VIC, AUSTRALIA;

2Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, AUSTRALIA;

3Exercise and Nutrition Research Program, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne VIC, AUSTRALIA;

4Melbourne Cancer Care, Cabrini Health, Brighton, VIC, AUSTRALIA;

5Translational Breast Cancer Genomics Laboratory, Peter MacCallum Cancer Centre, Melbourne, VIC, AUSTRALIA;

6Department of Cardiovascular Sciences, KU Leuven, Leuven, BELGIUM;

7Integrated Cardiovascular Exercise Physiology and Rehabilitation (iCARE) Laboratory, College of Nursing and Health Innovation, University of Texas Arlington, Arlington, TX; and

8Cardiology Department, St Vincent’s Hospital Melbourne, Melbourne VIC, AUSTRALIA

Address for correspondence: André La Gerche, M.D., Ph.D., Clinical Research Domain, Baker Heart and Diabetes Institute, 75 Commercial Rd., Melbourne 3004, VIC, Australia; E-mail: Andre.LaGerche@baker.edu.au.

Submitted for publication October 2018.

Accepted for publication February 2019.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.acsm-msse.org).

Online date: March 4, 2019

© 2019 American College of Sports Medicine