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Myocardial work and exercise LVEF as predictors of impaired cardiorespiratory fitness in breast cancer patients treated with anthracyclines
Session:
SESSÃO DE COMUNICAÇÕES ORAIS 14 - PRÉMIO JOVEM INVESTIGADOR (CLÍNICA E BÁSICA)
Speaker:
Margarida De Castro
Congress:
CPC 2025
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.6 Cardio-Oncology
Session Type:
Comunicações Orais
FP Number:
---
Authors:
MARGARIDA DE CASTRO; Luísa Pinheiro; Mariana Tinoco; Emídio Mata; Bárbara Lage; Tamara Pereira; Mário Lourenço; Alexandra Teixeira; Mafalda Cunha; Olga Azevedo; João Português; António Lourenço
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">Introduction:</span></span></strong> <span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">Anthracycline chemotherapy (AC) for breast cancer (BC) patients may be responsible for cancer therapy-related cardiac dysfunction (CTRCD). Alternative echocardiographic markers, besides LVEF and GLS, are being explored for their potential in early detection of CTRCD. In addition, impaired CRF has been recognized as a predictor of development of heart failure (HF).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">Purpose: </span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">To explore the effects of AC on advanced echocardiographic parameters at rest and during exercise in BC patients (pts); and to assess whether these parameters are associated with impaired cardiorespiratory fitness (CRF).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">Methods</span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">: We conducted a prospective study involving women with early-stage BC undergoing AC, <span style="color:black">with or without radiotherapy, and without HER2-directed therapies,</span> <span style="color:black">between May 2022 and December 2023</span>.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">Each pt had 3 visits: before starting AC, early after (1-month), and at short-term follow-up (FU) (6-months) after completing AC. During each visit, the pts performed cardiopulmonary exercise test (CPET) with <span style="color:black">modified Bruce protocol on a treadmill</span> and resting and exercise echocardiogram</span></span><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">Functional disability (FD) was defined as a Vo2peak ≤18.0mL/kg/min at CPET. </span></span><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif"><span style="color:black">Vo2peak was defined as the highest oxygen consumption rate over a 15-20 second interval in the last 90 seconds of exercise.</span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">Results: </span></span></strong><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="color:black">32 women were included, with a mean age of 50.8±9.3 years. </span></span></span></span><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="color:black">The mean cumulative dose of AC (doxorubicin) was 230±21 mg/m². </span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="color:black">All pts met the criteria for maximum exercise testing. Before AC, the mean Vo2peak was 22.7±3.7 mL/kg/min. It dropped to 18.6±3.7 mL/kg/min at 1-month (p<0.001) and to 19.7±4.7 mL/kg/min at 6-months (p<0.001). </span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">FD increased from 9% pre-AC to 44% at 1-month and 53% at 6-months post-AC. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="color:black">One-month post-AC, patients with FD had lower LVEF (62.8±</span></span></span></span><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="color:black">5.9 vs. 69.5±3.6%), contractile reserve (1.4±7.9 vs. 8.8±4.2%) and stroke volume (SV) (68.6±13.5 vs. 87.7±24.4 ml) during exercise.</span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="color:black">Six-months post-AC, patients with FD had lower SV (46.6±9.8 vs. 60.3±11.4 ml/beat) and CO (3.4±0.6 vs. 4.6±1.2 L/min), lower 2D-GLS (-17.4±1.7% vs. -19.6±2.0%), global work index (GWI) (1457±241 vs. 1729±250 mmHg%, p=0,014), and global constructive work (GCW) (1768±299 vs. 1989±293 mmHg%) at rest than patients without FD. During exercise, these patients also had lower SV (66.9±19.3 vs. 86.4±26 ml). </span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="background-color:white"><span style="font-family:"Times New Roman",serif"><span style="color:black">In univariate analysis (table 1.), age, GWI, exercise LVEF, exercise CO significantly influenced Vo2peak during follow-up. </span></span></span></span><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">In our multivariable model (table 1.), resting GWI and exercise LVEF were independently associated with Vo2peak.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">Conclusion: </span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Times New Roman",serif">Significant and persistent CRF reductions are common in BC pts post-AC. While current echocardiographic markers of CTRCD, such as resting LVEF and GLS, were not associated to CRF measured by Vo2peak, resting GWI and exercise LVEF were. As CRF is a predictor of HF risk, resting GWI and exercise LVEF could be useful echo markers to identify pts at increased long-term risk of HF.</span></span></span></span></p>
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