Deceleration capacity of heart rate predicts trastuzumab‐related cardiotoxicity in patients with HER2‐positive breast cancer: A prospective observational study

Feng, Yanying; Qin, Zhenhua; Yang, Zhijun

doi:10.1111/jcpt.13258

Cited by 7 publications

(7 citation statements)

References 21 publications

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“…Lakoski et al observed SNS overdrive and reduced PSNS efficacy related to CTRCD in BC patients [ 6 ]. Feng et al reported lower root mean square of successive differences (RMSSD), SDNN and DC values in HER2 + BC treated with Trastuzumab [ 11 ]. Tjeerdsma et al found that BC patients on anthracycline-based chemotherapy exhibited nearly 85% abnormal HRV, specifically in PSNS parameters like RMSSD and pNN50 [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…In a two-year prospective observational study of HER2 + BC patients treated with trastuzumab, Feng et al analyzed the association of HRV changes and cardiotoxicity. They found that deceleration capacity (DC) had higher sensitivity and specificity in predicting cardiotoxicity than baseline LVEF, and reduced DC correlated with earlier onset [ 11 ]. However, another prospective study with BC patients treated with epirubicin showed no persistent alterations in diastolic function and HRV [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Heart rate variability-based prediction of early cardiotoxicity in breast-cancer patients treated with anthracyclines and trastuzumab

Luna-Alcala,

Espejel-Guzmán,

Lerma

et al. 2024

Cardio-Oncology

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Background Cardiotoxicity is a recognized complication in breast cancer (BC) patients undergoing chemotherapy with anthracyclines with or without trastuzumab. However, the prognostic value of heart rate variability (HRV) indexes for early cardiotoxicity development remains unknown. Methods Fifty BC patients underwent TTE assessment before and three months after chemotherapy. HRV indexes were obtained from continuous electrocardiograms in supine position with spontaneous breathing, active standing, and supine position with controlled breathing. The magnitude of change (Δ) between supine-standing and supine-controlled breathing was calculated. Variables were compared using t-test or ANOVA. Cardiotoxicity predictive value was assessed by ROC curve analysis. A p value of < 0.05 was considered significant. Results TTE revealed reduced left atrial conduit strain in the cardiotoxicity group. Mean heart rate increased during all maneuvers at follow-up, with no differences in HRV indexes between patients with or without cardiotoxicity. However, a lower Δ in supine-controlled breathing of several HRV indexes predicted early cardiotoxicity identified by echocardiography (e.g. SDNN ≤ -8.44 ms: Sensitivity = 75%, Specificity = 69%). Conclusions BC patients treated with chemotherapy maintain cardiac autonomic responses to physiological stimuli after 3 months of chemotherapy. However, a lower Δ during active standing and controlled breathing before chemotherapy may predict early cardiotoxicity.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Heart rate variability-based prediction of early cardiotoxicity in breast-cancer patients treated with anthracyclines and trastuzumab

Luna-Alcala,

Espejel-Guzmán,

Lerma

et al. 2024

Cardio-Oncology

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“…DC and AC represent emerging noninvasive techniques for evaluating autonomic modulation ( Bauer et al, 2006a ; Zou et al, 2016 ). Recent observational studies have shown that DC was an effective predictor of epirubicin-related or trastuzumab-related cardiotoxicity development in patients with breast cancer ( Feng and Yang, 2015 ; Feng et al, 2021 ). Our study determined that thoracic radiotherapy can significantly decrease DC while simultaneously increasing AC.…”

Section: Discussionmentioning

confidence: 99%

“…Previous research has underscored the prognostic value of DC, AC, and HRV in the early detection of cardiovascular disease onset and sudden cardiac death rates in patients with conditions like myocardial infarction, heart failure, dilated cardiomyopathy, or coronary artery disease ( Arsenos et al, 2016 ; Zou et al, 2016 ; Wang et al, 2017 ; Rizas et al, 2018 ; Fang et al, 2020 ). More recent observational studies have established that DC is a potent predictor of cardiovascular toxicity stemming from treatments like epirubicin or trastuzumab in breast cancer patients ( Feng and Yang, 2015 ; Feng et al, 2021 ). Hence, the incorporation of DC, AC, and HRV in clinical studies investigating potential cardiovascular toxicity resulting from antitumor therapy could prove beneficial.…”

Section: Introductionmentioning

confidence: 99%

Assessment of short-term effects of thoracic radiotherapy on the cardiovascular parasympathetic and sympathetic nervous systems

Wu,

Guan,

Zhao

et al. 2023

Front. Neurosci.

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BackgroundPrior research suggests that cardiovascular autonomic dysfunction might be an early marker of cardiotoxicity induced by antitumor treatment and act as an early predictor of cardiovascular disease-related morbidity and mortality. The impact of thoracic radiotherapy on the parasympathetic and sympathetic nervous systems, however, remains unclear. Therefore, this study aimed to evaluate the short-term effects of thoracic radiotherapy on the autonomic nervous system, using deceleration capacity (DC), acceleration capacity (AC) of heart rate, and heart rate variability (HRV) as assessment tools.MethodsA 5 min electrocardiogram was collected from 58 thoracic cancer patients before and after thoracic radiotherapy for DC, AC, and HRV analysis. HRV parameters employed included the standard deviation of the normal-normal interval (SDNN), root mean square of successive interval differences (RMSSD), low frequency power (LF), high frequency power (HF), total power (TP), and the LF to HF ratio. Some patients also received systemic therapies alongside radiotherapy; thus, patients were subdivided into a radiotherapy-only group (28 cases) and a combined radiotherapy and systemic therapies group (30 cases) for additional subgroup analysis.ResultsThoracic radiotherapy resulted in a significant reduction in DC (8.5 [5.0, 14.2] vs. 5.3 [3.5, 9.4], p = 0.002) and HRV parameters SDNN (9.9 [7.03, 16.0] vs. 8.2 [6.0, 12.4], p = 0.003), RMSSD (9.9 [6.9, 17.5] vs. 7.7 [4.8, 14.3], p = 0.009), LF (29 [10, 135] vs. 24 [15, 50], p = 0.005), HF (35 [12, 101] vs. 16 [9, 46], p = 0.002), TP (74 [41, 273] vs. 50 [33, 118], p < 0.001), and a significant increase in AC (−8.2 [−14.8, −4.9] vs. -5.8 [−10.1, −3.3], p = 0.003) and mean heart rate (79.8 ± 12.6 vs. 83.9 ± 13.6, p = 0.010). Subgroup analysis indicated similar trends in mean heart rate, DC, AC, and HRV parameters (SDNN, RMSSD, LF, HF, TP) in both the radiotherapy group and the combined treatment group post-radiotherapy. No statistically significant difference was noted in the changes observed in DC, AC, and HRV between the two groups pre- and post-radiotherapy.ConclusionThoracic radiotherapy may induce cardiovascular autonomic dysfunction by reducing parasympathetic activity and enhancing sympathetic activity. Importantly, the study found that the concurrent use of systemic therapies did not significantly amplify or contribute to the alterations in autonomic function in the short-term following thoracic radiotherapy. DC, AC and HRV are promising and feasible biomarkers for evaluating autonomic dysfunction caused by thoracic radiotherapy.

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“…A recent study that examined the association between DC and survival in patients with malignant tumours found that DC assessed the risk stratification of emergency patients with malignant disease (Boehm et al, 2018). In addition, studies have shown that DC is an effective predictor of the risk of antineoplastic treatment-related cardiotoxicity in breast cancer patients (Feng and Yang, 2015;Feng et al, 2021). Although DC and AC may have higher specificity and sensitivity in patient stratification based on risk of death from heart disease than traditional detection techniques, they are rarely used in studies related to malignant tumours.…”

Section: Introductionmentioning

confidence: 99%

Prognostic role of short-term heart rate variability and deceleration/acceleration capacities of heart rate in extensive-stage small cell lung cancer

Wu,

Guan,

Zhao

et al. 2023

Front. Physiol.

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Background: Prior research suggests that autonomic modulation investigated by heart rate variability (HRV) might act as a novel predictive biomarker for cancer prognosis, such as in breast cancer and pancreatic cancer. It is not clear whether there is a correlation between autonomic modulation and prognosis in patients with extensive-stage small cell lung cancer (ES-SCLC). Therefore, the purpose of the study was to examine the association between short-term HRV, deceleration capacity (DC) and acceleration capacity (AC) of heart rate and overall survival in patients with ES-SCLC.Methods: We recruited 40 patients with ES-SCLC, and 39 were included in the final analysis. A 5-min resting electrocardiogram of patients with ES-SCLC was collected using a microelectrocardiogram recorder to analyse short-term HRV, DC and AC. The following HRV parameters were used: standard deviation of the normal-normal intervals (SDNN) and root mean square of successive interval differences (RMSSD). Overall survival of patients with ES-SCLC was defined as time from the date of electrocardiogram measurement to the date of death or the last follow-up. Follow-up was last performed on 07 June 2023. There was a median follow-up time of 42.2 months.Results: Univariate analysis revealed that the HRV parameter SDNN, as well as DC significantly predicted the overall survival of ES-SCLC patients (all p < 0.05). Multivariate analysis showed that the HRV parameters SDNN (hazard ratio = 5.254, 95% CI: 1.817–15.189, p = 0.002), RMSSD (hazard ratio = 3.024, 95% CI: 1.093–8.372, p = 0.033), as well as DC (hazard ratio = 3.909, 95% CI: 1.353–11.293, p = 0.012) were independent prognostic factors in ES-SCLC patients.Conclusion: Decreased HRV parameters (SDNN, RMSSD) and DC are independently associated with shorter overall survival in ES-SCLC patients. Autonomic nervous system function (assessed based on HRV and DC) may be a new biomarker for evaluating the prognosis of patients with ES-SCLC.

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Deceleration capacity of heart rate predicts trastuzumab‐related cardiotoxicity in patients with HER2‐positive breast cancer: A prospective observational study

Cited by 7 publications

References 21 publications

Heart rate variability-based prediction of early cardiotoxicity in breast-cancer patients treated with anthracyclines and trastuzumab

Heart rate variability-based prediction of early cardiotoxicity in breast-cancer patients treated with anthracyclines and trastuzumab

Assessment of short-term effects of thoracic radiotherapy on the cardiovascular parasympathetic and sympathetic nervous systems

Prognostic role of short-term heart rate variability and deceleration/acceleration capacities of heart rate in extensive-stage small cell lung cancer

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