Cardiovascular effects after treatment with anthracycline-containing chemotherapy (Anth-C) appear to be isolated to the heart, with none of the previously reported adverse effects of Anth-C on the vasculature in the years after treatment, a study published online ahead of print in the journal The Oncologist has shown.1
Anth-C treatment is associated with long-term cardiovascular mortality. The researchers sought to determine whether previously reported vascular dysfunction persists long-term or negatively influences cardiac function.
In this study, echocardiography was used to measure arterial elastance (Ea), end-systolic elastance (Ees), and ventricular-arterial coupling (Ea/Ees) during rest and exercise. Resting vascular function (flow-mediated dilation) and structure (carotid intima-media thickness, arterial stiffness) were also measured.
The study included 30 breast cancer survivors (6.5 ± 3.6 years after treatment with Anth-C) with normal left ventricular ejection fraction (LVEF) (60% ± 6%) and 30 matched controls. No differences in the echocardiographic measures were seen between the groups at rest. Normal exercise-induced increase in Ees was weaker at 50% and 75% of maximal workload (P<.01) and Ea/Ees was higher at all workloads in the breast cancer survivors compared with the controls (P<.01). No differences in vascular structure and function were observed between the two groups (P>.05).
Ventricular-arterial coupling was significantly weakened during exercise in the years following treatment with Anth-C.
This effect was primarily attributed to decreased LV contractility, indicated by a reduced Ees. No differences in Ea were observed; therefore, the researchers conclude the subclinical dysfunction appears to be isolated to the heart.
Furthermore, vascular structure and function were comparable between the breast cancer survivors and controls, indicating that adverse effects of Anth-C previously reported may not persist in the years after treatment.
1. Koelwyn GJ, Lewis NC, Ellard SL, et al. Ventricular-arterial coupling in breast cancer patients after treatment with anthracycline-containing adjuvant chemotherapy [published online ahead of print January 13, 2016]. Oncologist. doi:10.1634/theoncologist.2015-0352.