Vascular and autonomic changes in adult cancer patients receiving anticancer chemotherapy

Abstract

Chemotherapy is associated with acute and long-term cardiotoxicity. To date, risk assessment has primarily focused on the heart; however, recent findings suggest that vascular and autonomic function may also be compromised. Whether this occurs during chemotherapy treatment remains unknown. Therefore, the present study evaluated carotid artery stiffness, cardiovagal baroreflex sensitivity (cBRS), and heart rate variability (HRV) in cancer patients currently being treated with adjuvant chemotherapy. Eleven current cancer patients receiving adjuvant chemotherapy and 11 matched (1:1) controls were studied. Carotid artery stiffness was assessed via two-dimensional ultrasonography. cBRS was assessed from the spontaneous changes in beat-to-beat time series of R-R interval and systolic blood pressure via the cross-correlation technique. HRV was assessed using the standard deviation of R-R intervals (SDNN) and low (LF) and high (HF) power frequencies. Carotid artery β-stiffness was significantly higher in the cancer patients compared with control participants (8.0 ± 0.8 vs. 6.3 ± 0.6 U, respectively; P = 0.02). cBRS was lower in the cancer patients compared with controls (4.3 ± 0.7 vs. 10.7 ± 1.9 ms/mmHg, respectively; P = 0.01), and all indices of HRV were lower in the cancer patients (SDNN, P = 0.02; LF, P = 0.01; HF, P = 0.02). There was no significant correlation between β-stiffness and cBRS ( P = 0.4). However, LF power was significantly correlated with cBRS (r = 0.66, P < 0.001). Compared with matched healthy controls, cancer patients undergoing chemotherapy demonstrated a significantly higher arterial stiffness and lower cBRS. The previously reported adverse effects of chemotherapy on the heart appear to also influence other aspects of cardiovascular health. NEW & NOTEWORTHY Patients treated with anticancer chemotherapy exhibit an impaired baroreflex control of arterial blood pressure and increased arterial stiffness. These findings hold significant value, in particular as part of a risk-stratification strategy in current cancer patients receiving chemotherapy. This is the first investigation, to our knowledge, to demonstrate an attenuated spontaneous baroreflex control of arterial blood pressure in cancer patients currently undergoing chemotherapy.

Lower cutaneous microvascular reactivity in adult cancer patients receiving chemotherapy

“…Given that current standard chemotherapy practice often involves combination or sequential chemotherapy regimens with multiple agents (11), it was appropriate to include all patients in the study. The inclusion of this normal, but diverse, group of chemotherapy agents is consistent with previous investigations by our laboratory and others aimed at evaluating the adverse changes in arterial stiffness and vascular control with anticancer chemotherapy (8,18,23,27,46). Since the timing between cancer diagnosis, possible surgery, and onset of chemotherapy is often limited, a cross-sectional study design was utilized.…”

Anthracycline chemotherapy‐mediated vascular dysfunction as a model of accelerated vascular aging

“…Middle-aged patients also appear to undergo arterial stiffening in response to treatment with anthracyclines. For example, Frye et al 44 recently demonstrated ∼20% greater carotid artery β stiffness in middle-aged (mean age: 56 years) patients receiving anthracycline chemotherapy relative to age-matched controls. In another study, Chaosuwannakit et al 45 showed that 4 months following completion of anthracycline treatment in middle-aged patients, there was a three-fold increase in carotid-femoral PWV from baseline relative to controls.…”

Tracking Cancer: Exploring Heart Rate Variability Patterns by Cancer Location and Progression

“…Moreover, these studies have suggested that the upregulation of the SNS and/or PNS may also promote tumor growth and metastasis [ 18 , 19 ]. More importantly, studies have observed larger decrements in HRV among cancer patients in the advanced stages which were associated with poorer prognosis, increased mortality risk, and decreased survivorship following surgical operations and pharmaceutical interventions [ 13 , 20 , 21 ]. While scientific evidence reliably shows depressed HRV patterns among patients diagnosed with cancer, much less is known about whether specific cancer locations such as gastrointestinal and breast cancer can elicit varying HRV patterns at different stages.…”