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

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Koelwyn, GJ; Lewis, NC; Ellard, SL; Jones, LW; Gelinas, JC; Rolf, JD; Melzer, B; Thomas, SM; Douglas, PS; Khouri, MG; Eves, ND
Published in: Oncologist
February 2016

BACKGROUND: Anthracycline-containing chemotherapy (Anth-C) is associated with long-term cardiovascular mortality. Although cardiovascular risk assessment has traditionally focused on the heart, evidence has demonstrated that vascular dysfunction also occurs during and up to 1 year following Anth-C. Whether vascular dysfunction persists long-term or negatively influences cardiac function remains unknown. Hence, the present study evaluated ventricular-arterial coupling, in concert with measures of vascular structure and function, in the years following Anth-C. METHODS: Arterial elastance (Ea), end-systolic elastance (Ees), and ventricular-arterial coupling (Ea/Ees) were measured during rest and exercise using echocardiography. Resting vascular function (flow-mediated dilation) and structure (carotid intima-media thickness, arterial stiffness) were also measured. RESULTS: Thirty breast cancer survivors (6.5 ± 3.6 years after Anth-C) with normal left ventricular ejection fraction (LVEF) (60% ± 6%) and 30 matched controls were studied. At rest, no differences were found in Ea, Ees, Ea/Ees, or LVEF between groups. The normal exercise-induced increase in Ees was attenuated in survivors at 50% and 75% of maximal workload (p < .01). Ea/Ees was also higher at all workloads in the survivors compared with the controls (p < .01). No differences in vascular structure and function were observed between the two groups (p > .05). CONCLUSION: In the years after Anth-C, ventricular-arterial coupling was significantly attenuated during exercise, primarily owing to decreased LV contractility (indicated by a reduced Ees). This subclinical dysfunction appears to be isolated to the heart, as no differences in Ea were observed. The previously reported adverse effects of Anth-C on the vasculature appear to not persist in the years after treatment, as vascular structure and function were comparable to controls. IMPLICATIONS FOR PRACTICE: Anthracycline-induced cardiotoxicity results in significantly impaired ventricular-arterial coupling in the years following chemotherapy, owing specifically to decreased left ventricular contractility. This subclinical dysfunction was identified only under exercise stress. A comprehensive evaluation of vascular structure and function yielded no differences between those treated with anthracyclines and controls. Combined with a stress stimulus, ventricular-arterial coupling might hold significant value beyond characterization of integrative cardiovascular function, in particular as a part of a risk-stratification strategy after anthracycline-containing chemotherapy. Although vascular function and structure were not different in this cohort, this does not undermine the importance of identifying vascular (dys)function in this population, because increases in net arterial load during exercise might amplify the effect of reductions in contractility on cardiovascular function after anthracycline-containing chemotherapy.

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Published In

Oncologist

DOI

EISSN

1549-490X

Publication Date

February 2016

Volume

21

Issue

2

Start / End Page

141 / 149

Location

England

Related Subject Headings

  • Ventricular Function, Left
  • Risk Factors
  • Oncology & Carcinogenesis
  • Middle Aged
  • Humans
  • Female
  • Exercise
  • Echocardiography
  • Chemotherapy, Adjuvant
  • Carotid Intima-Media Thickness
 

Citation

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Chicago
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MLA
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Koelwyn, G. J., Lewis, N. C., Ellard, S. L., Jones, L. W., Gelinas, J. C., Rolf, J. D., … Eves, N. D. (2016). Ventricular-Arterial Coupling in Breast Cancer Patients After Treatment With Anthracycline-Containing Adjuvant Chemotherapy. In Oncologist (Vol. 21, pp. 141–149). England. https://doi.org/10.1634/theoncologist.2015-0352
Koelwyn, Graeme J., Nia C. Lewis, Susan L. Ellard, Lee W. Jones, Jinelle C. Gelinas, J Douglass Rolf, Bernie Melzer, et al. “Ventricular-Arterial Coupling in Breast Cancer Patients After Treatment With Anthracycline-Containing Adjuvant Chemotherapy.” In Oncologist, 21:141–49, 2016. https://doi.org/10.1634/theoncologist.2015-0352.
Koelwyn GJ, Lewis NC, Ellard SL, Jones LW, Gelinas JC, Rolf JD, et al. Ventricular-Arterial Coupling in Breast Cancer Patients After Treatment With Anthracycline-Containing Adjuvant Chemotherapy. In: Oncologist. 2016. p. 141–9.
Koelwyn, Graeme J., et al. “Ventricular-Arterial Coupling in Breast Cancer Patients After Treatment With Anthracycline-Containing Adjuvant Chemotherapy.Oncologist, vol. 21, no. 2, 2016, pp. 141–49. Pubmed, doi:10.1634/theoncologist.2015-0352.
Koelwyn GJ, Lewis NC, Ellard SL, Jones LW, Gelinas JC, Rolf JD, Melzer B, Thomas SM, Douglas PS, Khouri MG, Eves ND. Ventricular-Arterial Coupling in Breast Cancer Patients After Treatment With Anthracycline-Containing Adjuvant Chemotherapy. Oncologist. 2016. p. 141–149.

Published In

Oncologist

DOI

EISSN

1549-490X

Publication Date

February 2016

Volume

21

Issue

2

Start / End Page

141 / 149

Location

England

Related Subject Headings

  • Ventricular Function, Left
  • Risk Factors
  • Oncology & Carcinogenesis
  • Middle Aged
  • Humans
  • Female
  • Exercise
  • Echocardiography
  • Chemotherapy, Adjuvant
  • Carotid Intima-Media Thickness