Cardiac dysfunction in cancer survivors unmasked during exercise

Kearney, Maria; Gallop‐Evans, Eve; Cockcroft, John R.; Stöhr, Eric J.; Lee, Eveline; Backx, Karianne; Haykowsky, Mark J.; Yousef, Zaheer; Shave, Rob

doi:10.1111/eci.12720

Cited by 8 publications

(3 citation statements)

References 36 publications

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“…To the best of our knowledge, our randomized controlled study is the first to have measured maximum cardiac output (CO) during exercise testing before and after long-term exercise interventions in post-surgery cancer patients. So far, exercise data on CO in cancer patients has only been collected during acute exercise and under resting conditions [ 54 – 56 ]. Evidence from healthy subjects suggests that exercise training, particularly interval training, helps improve the pumping function [ 57 ] and seems to be significantly enhanced by enlarging the blood volume [ 58 , 59 ].…”

Section: Discussionmentioning

confidence: 99%

Effect of home-based online training and activity feedback on oxygen uptake in patients after surgical cancer therapy: a randomized controlled trial

Falz

Bischoff

Thieme

et al. 2023

BMC Med

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Background Exercise training is beneficial in enhancing physical function and quality of life in cancer patients. Its comprehensive implementation remains challenging, and underlying cardiopulmonary adaptations are poorly investigated. This randomized controlled trial examines the implementation and effects of home-based online training on cardiopulmonary variables and physical activity. Methods Of screened post-surgical patients with breast, prostate, or colorectal cancer, 148 were randomly assigned (1:1) to an intervention (2 × 30 min/week of strength-endurance training using video presentations) and a control group. All patients received activity feedback during the 6-month intervention period. Primary endpoint was change in oxygen uptake after 6 months. Secondary endpoints included changes in cardiac output, rate pressure product, quality of life (EORTC QoL-C30), C-reactive protein, and activity behavior. Results One hundred twenty-two patients (62 intervention and 60 control group) completed the study period. Change in oxygen uptake between intervention and control patients was 1.8 vs. 0.66 ml/kg/min (estimated difference after 6 months: 1.24; 95% CI 0.23 to 2.55; p = 0.017). Rate pressure product was reduced in IG (estimated difference after 6 months: − 1079; 95% CI − 2157 to − 1; p = 0.05). Physical activity per week was not different in IG and CG. There were no significant interaction effects in body composition, cardiac output, C-reactive protein, or quality of life. Conclusions Home-based online training among post-surgery cancer patients revealed an increase of oxygen uptake and a decrease of myocardial workload during exercise. The implementation of area-wide home-based training and activity feedback as an integral component in cancer care and studies investigating long-term effects are needed. Trial registration DRKS-ID: DRKS00020499; Registered 17 March 2020.

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Section: Discussionmentioning

confidence: 99%

Effect of home-based online training and activity feedback on oxygen uptake in patients after surgical cancer therapy: a randomized controlled trial

Falz

Bischoff

Thieme

et al. 2023

BMC Med

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show abstract

“…Equally, sometimes the matching of the change in heart rate between groups may lead to unequal workloads or changes in blood pressure, highlighting again the need to interpret myocardial deformation during exercise in the context of general physiological responses. Notwithstanding, the overall trend is that LV myocardial deformation in patients is reduced in response to an acute exercise challenge, including in cardiac amyloidosis, hypertension, cancer, coronary artery disease, as well as in patients with valve disease before and after surgical correction [84][85][86][87][88][89]. Some subtle observations, however, are worthy of discussion.…”

Section: Exercise Responses In Patients With Cardiovascular Diseasementioning

confidence: 99%

Echocardiographic Assessment of Myocardial Deformation during Exercise

Stöhr¹,

Samuel²

2021

Advanced Concepts in Endocarditis - 2021

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The human heart is an asymmetrical structure that consists of oblique, circumferential, and transmural fibers, as well as laminae and sheets. Sequential electrical activation of all the muscle fibers ultimately results in a coordinated contraction of the heart muscle also referred to as "deformation." This is immediately followed by myocardial relaxation, when the preceding deformation is reversed, and the ventricles fill with blood. Given the complexity of these repetitive motions, it is not surprising that there is great diversity in the myocardial deformation between different individuals and between distinct populations. Exercise presents a natural challenge to determine the full capacity of an individual's heart, and modern imaging technologies allow for the non-invasive assessment of myocardial deformation during exercise. In this chapter, the most relevant anatomical basis for myocardial deformation is summarized and definitions of the most relevant parameters are provided. Then, the general cardiac responses to exercise are highlighted before the current knowledge on myocardial deformation during exercise is discussed. The literature clearly indicates that the echocardiographic evaluation of myocardial deformation during exercise holds great promise for the identification of sub-clinical disease. Future studies should aim to determine the mechanisms of differential expression of myocardial deformation during exercise in health and disease.

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“…There are a number of studies (primarily cross-sectional) comparing cardiac reserve in pediatric cancer survivors treated with cardiotoxic therapies, largely anthracycline chemotherapy, to matched healthy controls (135)(136)(137)(138)(139)(140)(141)(142)(143)(144)(145). Compared to control subjects, blunted increases in LVEF or fractional shortening (135-137, 140, 146), attenuated increases in stroke volume and cardiac index (138,141,142,144) or a blunted increase in LV longitudinal and circumferential strain (147) have all been reported. Another important question regarding the use of cardiac reserve in cancer patients is its ability to detect sub-clinical dysfunction.…”

Section: The Utility Of Cardiac Reserve In Cancer Patients Exposed Tomentioning

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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Cardiac dysfunction in cancer survivors unmasked during exercise

Abstract: In contrast to resting echocardiography, the measurement of LV deformation at rest and during exercise provides a more comprehensive characterisation of subclinical LV dysfunction. Larger studies are required to determine the clinical relevance of these preliminary findings.

Cited by 8 publications

References 36 publications

Effect of home-based online training and activity feedback on oxygen uptake in patients after surgical cancer therapy: a randomized controlled trial

Effect of home-based online training and activity feedback on oxygen uptake in patients after surgical cancer therapy: a randomized controlled trial

Echocardiographic Assessment of Myocardial Deformation during Exercise

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

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