The utility of cardiac stress testing for detection of cardiovascular disease in breast cancer survivors: a systematic review

Abstract

BackgroundHeart function tests performed with myocardial stress, or “cardiac stress tests”, may be beneficial for detection of cardiovascular disease. Women who have been diagnosed with breast cancer are more likely to develop cardiovascular diseases than the general population, in part due to the direct toxic effects of cancer treatment on the cardiovascular system. The aim of this review was to determine the utility of cardiac stress tests for the detection of cardiovascular disease after cardiotoxic breast cancer treatment.DesignSystematic review.MethodsMedline and Embase were searched for studies utilizing heart function tests in breast cancer survivors. Studies utilizing a cardiac stress test and a heart function test performed at rest were included to determine whether stress provided added benefit to identifying cardiac abnormalities that were undetected at rest within each study.ResultsFourteen studies were identified. Overall, there was a benefit to utilizing stress tests over tests at rest in identifying evidence of cardiovascular disease in five studies, a possible benefit in five studies, and no benefit in four studies. The most common type of stress test was myocardial perfusion imaging, where reversible perfusion defects were detected under stress in individuals who had no defects at rest, in five of seven studies of long-term follow-up. Two studies demonstrated the benefit of stress echocardiography over resting echocardiography for detecting left ventricular dysfunction in anthracycline-treated breast cancer survivors. There was no benefit of stress cardiac magnetic resonance imaging in one study. Two studies showed a potential benefit of stress electrocardiography, whereas three others did not.ConclusionThe use of cardiac stress with myocardial perfusion imaging and echocardiography may provide added benefit to tests performed at rest for detection of cardiovascular disease in breast cancer survivors, and merits further research.

Pharmacological stress, rest perfusion and delayed enhancement cardiac magnetic resonance identifies very early cardiac involvement in systemic sclerosis patients of recent onset

“…Our data suggest that myocardial hypoperfusion may be a very early event in this disease in which recurrent ischemia-reperfusion injury and microvascular dysfunction might play a crucial pathophysiological role in the development of perfusion defects. 8,9 Our results confirm, in a very early subset of SSc patients, previous CMR studies showing myocardial involvement in SSc patients. 8,24,25,[28][29][30][31] Taking together our data and the results already published by different groups, we may speculate that, in the early phase of the disease, cardiac perfusion defects may be recognized also in absence of fibrosis, whereas in long-standing disease, fibrosis may be the main alteration observed in the SSc heart.…”

“…Myocardial fibrosis was detected in 43% of patients unrelated to coronary artery distribution without sub‐endocardial layer involvement . Moreover, cardiac stress tests might be a helpful technique to highlight the occult microvascular involvement, which cannot be detected at rest …”

“…8 Moreover, cardiac stress tests might be a helpful technique to highlight the occult microvascular involvement, which cannot be detected at rest. [8][9][10] In this paper, we evaluated the occult microvascular myocardial involvement leading to perfusion defects [11][12][13][14] in asymptomatic SSc patients by using pharmacological stress, rest-perfusion and delayed enhancement CMR.…”

Advancing breast cancer survivorship among African-American women

“…The potential late effects of cancer treatment includes second malignancies, cardiovascular disease, obesity, osteoporosis, bone fractures, and other chronic conditions affecting physical and emotional well-being [21–24]. The increased risk of cardiovascular disease among breast cancer survivors is due in part to the toxic effects of anticancer therapy (e.g., anthracyclines, trastuzumab, and radiation) on the cardiovascular system [25, 26]. …”

The Utility of Cardiac Reserve for the Early Detection of Cancer Treatment-Related Cardiac Dysfunction: A Comprehensive Overview

“…Cross-sectional studies of asymptomatic pediatric cancer survivors assessed with dobutamine stress echocardiography a number of years following anthracycline treatment (median 5.3-7 years) have shown cancer survivors have reduced posterior LV wall thickening, LVEF, and LV fractional shortening, decreased ratio of early to late peak mitral velocity (E/A), and increased LV wall stress during exercise compared to matched control subjects-demonstrating impairments in both systolic and diastolic reserve (148,149). Furthermore, the degree of impairment in cardiac reserve appears to relate to the dose of chemotherapy received (150). In contrast, Lanzarini et al found no differences in cardiac reserve in long-term (mean 7 years post-treatment) pediatric cancer survivors and matched sibling controls during low dose dobutamine stress echocardiography.…”