Cardiovascular autonomic function in anthracycline-treated breast cancer patients

Abstract

Preclinical studies suggest that in addition to the well-known direct damage to the myocardium, anthracycline antineoplastic drugs exert toxic effects on the cardiovascular autonomic system as well. To investigate whether this phenomenon occurs in the clinic, we carried out noninvasive, widely used tests of cardiovascular autonomic physiology in 55 women with stage II or III breast cancer. In all, 31 were being treated with anthracycline-containing chemotherapy regimens, and 24 who were receiving CMF (cyclophosphamide, Methotrexate, and fluorouracil) served as controls. Of 279 tests conducted in anthracycline (A)-treated patients, 123 were abnormal, vs 54 of 216 tests carried out in 24 controls (44% vs 25%; P less than 0.005). Abnormal variations in heart rate on standing and in diastolic blood pressure during handgrip was found in 25 (81%) and 17 patients receiving A, vs 9 (37%; P less than 0.005) and 5 (21%; P less than 0.0001), respectively, in controls. The incidence of abnormal tests was significantly higher in A-treated patients greater than 60 years of age (41%) vs 67%; P less than 0.05). Radionuclide ventriculography was carried out in 19 patients who showed abnormal tests of cardiovascular autonomic function after greater than or equal to 6 courses of a-containing chemotherapy; only 1 of them had abnormal cardiac contractility (global hypokinesia), suggesting that abnormal tests of cardiovascular autonomic function may occur in the absence of a detectable deterioration in left ventricular ejection fraction. A large number of factors may alter cardiovascular autonomic function in cancer patients, including age, radiation therapy to the chest, and multidrug treatment. Even after correcting for the most obvious of these, chemotherapy with anthracyclines is associated with a significantly higher percentage of abnormal tests for cardiovascular autonomic function. Although indirect and semi-quantitative, our results are compatible with the idea of A-induced cardiac autonomic dysfunction.

Neuroendocrine changes during the evolution of doxorubicin-induced left ventricular dysfunction in adult lymphoma patients

“…Effects of anthracycline therapy on HRV in humans have been reported previously [29][30][31][32][33]. Three of these studies were retrospective [29,31,32], and one study evaluated cardiac parasympathetic control [30].…”

Heart rate dynamics and cardiorespiratory coordination in diabetic and breast cancer patients

“…Mean heart rate level is linked with physical activity which may play an important role in lowering the risk to die of cancer. As far as we know, relationships between heart rate variability and cancer have only been reported analysing the influence of paclitaxel chemotherapy (Ekholm et al ., 2000) or of anthracycline treatment (Viniegra et al ., 1990). On the other hand, a large number of studies can be found demonstrating that circadian physiological rhythms are altered in breast cancer.…”

“…Heart rate dynamics in diabetes and breast cancer · H. Bettermann et al ...................................................................................................................................................................................................................................................................................................................... ..... important role in lowering the risk to die of cancer. As far as we know, relationships between heart rate variability and cancer have only been reported analysing the in¯uence of paclitaxel chemotherapy (Ekholm et al, 2000) or of anthracycline treatment (Viniegra et al, 1990). On the other hand, a large number of studies can be found demonstrating that circadian physiological rhythms are altered in breast cancer.…”

Neuroendocrine changes during the evolution of doxorubicin-induced left ventricular dysfunction in adult lymphoma patients

“…Effects of anthracycline therapy on HRV in humans have been reported previously [29][30][31][32][33]. Three of these studies were retrospective [29,31,32], and one study evaluated cardiac parasympathetic control [30]. In the study by Postma et al [31] an increase in LF components and a decrease in HF components of HRV were observed in children treated with higher cumulative doxorubicin doses exceeding 400 mg\m#.…”