Ventricular-Arterial Coupling in Breast Cancer Patients After Treatment With Anthracycline-Containing Adjuvant Chemotherapy

Koelwyn, Graeme J.; Lewis, Nia C. S.; Ellard, Susan L.; Jones, Lee W.; Gelinas, Jinelle; Rolf, Julia; Melzer, Bernie; Thomas, Samantha M.; Douglas, Pamela S.; Khouri, Michel G.; Eves, Neil D.

doi:10.1634/theoncologist.2015-0352

Cited by 31 publications

(19 citation statements)

References 33 publications

(41 reference statements)

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“…Peak VO 2 is a strong independent predictor of CVD, disability, and mortality in healthy and clinical populations [26]. Following BC treatment, women have a peak VO 2 that is on average 20% lower than age-matched healthy sedentary women [3][4][5][6][7][8]. The mechanisms responsible for the reduced exercise tolerance are not well understood; however, recent evidence suggests that "noncardiac" peripheral abnormalities associated with chemotherapy may be important contributors to reduced exercise tolerance [13,16].…”

Section: Discussionmentioning

confidence: 99%

“…Women with a history of BC are at greater risk for CVD and related mortality relative to women without BC. It is well established that following treatment for BC, cardiorespiratory fitness, measured as peak oxygen uptake (peak VO 2 ) during whole-body exercise, is ≈20% lower than age-and sex-matched controls [3][4][5][6][7][8]. Low cardiorespiratory fitness is associated with increased heart failure incidence, cardiovascular events, and both CVDrelated and all-cause mortality [9].…”

Section: Introductionmentioning

confidence: 99%

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Exercise Intolerance in Anthracycline-Treated Breast Cancer Survivors: The Role of Skeletal Muscle Bioenergetics, Oxygenation, and Composition

et al. 2020

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Background. Peak oxygen consumption (VO 2 ) is reduced in women with a history of breast cancer (BC). We measured leg blood flow, oxygenation, bioenergetics, and muscle composition in women with BC treated with anthracycline chemotherapy (n = 16, mean age: 56 years) and age-and body mass index-matched controls (n = 16). Materials and Methods. Whole-body peak VO 2 was measured during cycle exercise. 31 Phosphorus magnetic resonance (MR) spectroscopy was used to measure muscle bioenergetics during and after incremental to maximal plantar flexion exercise (PFE). MR imaging was used to measure lower leg blood flow, venous oxygen saturation (S v O 2 ), and VO 2 during submaximal PFE, and abdominal, thigh, and lower leg intermuscular fat (IMF) and skeletal muscle (SM). Results. Whole-body peak VO 2 was significantly lower in BC survivors versus controls (23.1 AE 7.5 vs. 29.5 AE 7.7 mL/kg/minute).Muscle bioenergetics and mitochondrial oxidative capacity were not different between groups. No group differences were found during submaximal PFE for lower leg blood flow, S v O 2 , or VO 2 . The IMF-to-SM ratio was higher in the thigh and lower leg in BC survivors (0.36 AE 0.19 vs. 0.22 AE 0.07, p = .01; 0.10 AE 0.06 vs. 0.06 AE 0.02, p = .03, respectively) and were inversely related to whole-body peak VO 2 (r = −0.71, p = .002; r = −0.68, p = .003, respectively) . In the lower leg, IMF-to-SM ratio was inversely related to VO 2 and O 2 extraction during PFE. Conclusion. SM bioenergetics and oxidative capacity in response to PFE are not impaired following anthracycline treatment. Abnormal SM composition (increased thigh and lower leg IMF-to-SM ratio) may be an important contributor to reduced peak VO 2 during whole-body exercise among anthracycline-treated BC survivors. The Oncologist 2020;25:e852-e860 Implications for Practice: Peak oxygen consumption (peak VO 2 ) is reduced in breast cancer (BC) survivors and is prognostic of increased risk of cardiovascular disease-related and all-cause mortality. Results of this study demonstrated that in the presence of deficits in peak VO 2 1 year after anthracycline therapy, skeletal muscle bioenergetics and oxygenation are not impaired. Rather, body composition deterioration (e.g., increased ratio of intermuscular fat to skeletal muscle) may contribute to reduced exercise tolerance in anthracycline BC survivors. This finding points to the importance of lifestyle interventions including caloric restriction and exercise training to restore body composition and cardiovascular health in the BC survivorship setting.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Exercise Intolerance in Anthracycline-Treated Breast Cancer Survivors: The Role of Skeletal Muscle Bioenergetics, Oxygenation, and Composition

et al. 2020

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“…However, the majority of studies focused on the role of stress imaging (such as myocardial perfusion imaging) or stress electrocardiography for the early detection of coronary artery disease, rather than the prediction of CTRCD. Two cross-sectional studies (n = 30-57) included in this systematic review compared cardiac reserve measured via 2D echocardiography among early stage breast cancer survivors previously treated with anthracyclines to age-and gendermatched controls (152,153). Whilst none of the breast cancer survivors met the criteria for cardiotoxicity determined by resting LVEF or global longitudinal strain, both studies found that breast cancer survivors had reduced cardiac reserve.…”

Section: Adult Cancer Survivorsmentioning

confidence: 99%

“…Whilst none of the breast cancer survivors met the criteria for cardiotoxicity determined by resting LVEF or global longitudinal strain, both studies found that breast cancer survivors had reduced cardiac reserve. Specifically, this included a lower LVEF at peak exercise (153), or a lower cardiac index and SV index at peak exercise (152). Recent work from our laboratory has shed some light on the evolution of cardiac reserve impairment in breast cancer patients undergoing anthracycline chemotherapy using exCMR (154,155).…”

Section: Adult Cancer Survivorsmentioning

confidence: 99%

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

Foulkes

Claessen

Howden

et al. 2020

Front. Cardiovasc. Med.

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“… 5 - 7 The reduced peak VO 2 in breast cancer survivors is partly a result of impaired peripheral vascular function that results in reduced blood flow and oxygen delivery to the active muscles. 7 - 10 Studies in adult cancer survivors report better, 11 - 13 not different, 14 - 16 or impaired 8 , 10 , 17 vascular endothelial function relative to age-matched controls.…”

Section: Introductionmentioning

confidence: 97%

Meta-analysis of Exercise Training on Vascular Endothelial Function in Cancer Survivors

et al. 2018

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Cancer and cardiovascular disease (CVD) are leading causes of morbidity and mortality in the United States. Vascular endothelial dysfunction, an important contributor in the development of CVD, improves with exercise training in patients with CVD. However, the role of regular exercise to improve vascular function in cancer survivors remains equivocal. We performed a meta-analysis to determine the effect of exercise training on vascular endothelial function in cancer survivors. We searched PubMed (1975 to 2016), EMBASE CINAHL (1937 to 2016), OVID MEDLINE (1948 to 2016), and Cochrane Central Registry of Controlled Trials (1991 to 2016) using search terms: vascular function, endothelial function, flow-mediated dilation [FMD], reactive hyperemia, exercise, and cancer. Studies selected were randomized controlled trials of exercise training on vascular endothelial function in cancer survivors. We calculated pooled effect sizes and performed a meta-analysis. We identified 4 randomized controlled trials (breast cancer, n=2; prostate cancer, n=2) measuring vascular endothelial function by FMD (n=3) or reactive hyperemia index (n=1), including 163 cancer survivors (exercise training, n=82; control, n=81). Aerobic exercise training improved vascular function (n=4 studies; standardized mean difference [95% CI]=0.65 [0.33, 0.96], I2=0%; FMD, weighted mean difference [WMD]=1.28 [0.22, 2.34], I2=23.2%) and peak exercise oxygen uptake (3 trials; WMD [95% CI]=2.22 [0.83, 3.61] mL/kg/min; I2=0%). Our findings indicate that exercise training improves vascular endothelial function and exercise capacity in breast and prostate cancer survivors.

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Ventricular-Arterial Coupling in Breast Cancer Patients After Treatment With Anthracycline-Containing Adjuvant Chemotherapy

Cited by 31 publications

References 33 publications

Exercise Intolerance in Anthracycline-Treated Breast Cancer Survivors: The Role of Skeletal Muscle Bioenergetics, Oxygenation, and Composition

Exercise Intolerance in Anthracycline-Treated Breast Cancer Survivors: The Role of Skeletal Muscle Bioenergetics, Oxygenation, and Composition

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

Meta-analysis of Exercise Training on Vascular Endothelial Function in Cancer Survivors

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