Non-invasive assessment of cardiac hemodynamics in patients with advanced cancer and with chronic heart failure: a pilot feasibility study

Abstract

IntroductionRelationships between cardiac pressure and volume have been suggested as markers of cardiac contractility; parameters include stroke work and the maximal rate of pressure rise during isovolumic contraction (dP/dtmax). Patients with cancer often display dyspnea and fatigue. These are also frequent symptoms in patients with chronic heart failure (HF). The reasons for similar symptoms in cancer patients are unknown. Using the novel Nexfin Finapres technique, we sought to assess measures of cardiac performance in patients with cancer and compare these values with those from control subjects and patients with chronic HF.Material and methodsWe prospectively studied 98 patients (control n = 18, chronic HF n = 37, advanced pancreatic or colorectal cancer n = 43) and assessed blood pressure (BP), stroke volume (SV), cardiac output (CO), and dP/dtmax at rest.ResultsAll parameters of interest could be assessed using the Nexfin Finapres technique with SV and CO being significantly higher in patients with cancer than in controls (both p < 0.05). The SV was significantly higher in patients with chronic HF than in controls (p < 0.05). In patients with cancer, SV correlated with age (r = –0.45, p < 0.01) and body weight (r = +0.55, p = 0.0001). In chronic HF, SV declined with increasing age (r = –0.49, p < 0.01); in control subjects, SV increased with increasing body weight (r = +0.57, p = 0.01).ConclusionsPatients with cancer tended to display elevated BP, CO, SV, and dP/dtmax as compared to control subjects and patients with HF. These findings may reveal an elevated risk for cardiovascular diseases in this group.

The systemic activin response to pancreatic cancer: implications for effective cancer cachexia therapy

“…Other organs also waste, however, including cardiac muscle and adipose tissue, two organs that clearly play an important role in cachexia and pancreatic cancer outcomes. [55][56][57][58][59] Here, we observed wasting of skeletal muscle, heart, fat, and multiple other organs, as well as activin induction in most of those organs. Mice with skeletal muscle-specific activin inhibition here showed preserved body weight with both activin low and activin high tumours but did not show prolonged survival, unlike WT mice bearing the same activin low tumours and treated with ACVR2B/Fc.…”

“…Muscle represents more than 40% of body weight, and thus, its wasting accounts for a large part of body weight loss in cachexia. Other organs also waste, however, including cardiac muscle and adipose tissue, two organs that clearly play an important role in cachexia and pancreatic cancer outcomes . Here, we observed wasting of skeletal muscle, heart, fat, and multiple other organs, as well as activin induction in most of those organs.…”

Influence of cancer cachexia on drug liver metabolism and renal elimination in rats

“…Increased cardiac output was observed in patients with cancer, and in rats, a slight increase in cardiac function was noted in early stages of cancer 12,32. This could, in part, be responsible for a transient rise in propranolol and iohexol clearance on D5.…”

“…Increased cardiac output was observed in patients with cancer, and in rats, a slight increase in cardiac function was noted in early stages of cancer. 12,32 This could, in part, be responsible for a transient rise in propranolol and iohexol clearance on D5. On the other hand, cardiac function was shown to be severely impaired in cancer cachexia 12 and could contribute to decreased renal and hepatic blood flow thereby affecting propranolol and iohexol elimination.…”

Resting heart rate is an independent predictor of death in patients with colorectal, pancreatic, and non‐small cell lung cancer: results of a prospective cardiovascular long‐term study

“…Previous work from our group has shown that patients with colorectal cancer demonstrate reduced exercise capacity as assessed by spiroergometry and that mildly, but significantly reduced LVEF, reduced heart rate variability, and reduced lean mass may be pathophysiologically important . In addition, cancer patients tend to present with higher cardiac output and a maximal rate of pressure rise during an isovolumic contraction than healthy control subjects, possibly adding additional stress to cardiac function in cancer . In patients with cardiovascular disease, we know that an elevated resting heart rate is a valid marker of all‐cause mortality as well as for outcomes in cardiac rehabilitation .…”