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.
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.
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).
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.
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Online date: March 4, 2019