부산대학교 도서관

Introduction: Detection of cancer therapy-related cardiac dysfunction (CTRCD) is a cornerstone of heart failure (HF) risk assessment. However, it is unclear how closely CTRCD definitions reflect typical HF features of reduced exercise tolerance (VO2peak) and blunted cardiac reserve.Hypothesis: Standard CTRCD metrics (resting LVEF and GLS) will show poor agreement with reduced VO2peak and changes in cardiac reserve following anthracycline chemotherapy (AC).Methods: This analysis used baseline (pre-AC) and 12-month assessments from a randomized trial of exercise training in breast cancer patients (n=104) undergoing AC ± anti-HER2 therapy. Assessments included resting echocardiography (LVEF and GLS), cardiopulmonary exercise testing (VO2peak) and exercise cardiac magnetic resonance (peak cardiac output [CO], stroke volume [SV] and LVEF [LVEFpeak]). CTRCD was defined as ≥10% absolute decline in LVEF to a value <50%, >15% decline in GLS, and a ≥10% decline in VO2peak from pre-AC.Results: Seventy-nine participants (76%) completed pre-AC and 12-month assessments, 14 of whom (18%) met LVEF and 30 (38%) met GLS CTRCD criteria (10% met both criteria). In addition to declines in resting LVEF and GLS, these participants showed a reduction in LVEFpeak, but no change in peak SV, CO or VO2peak (Figure 1A-B). In contrast, 19 participants (24%) had a ≥10% VO2peak decline (-17% vs Pre-AC, P<0.001) that coincided with a decline in peak SV (-6%, P=0.03), and LVEFpeak (-11%, P=0.02), with no significant change in resting LVEF or GLS (Figure 1C). Of those who met VO2peak criteria, only three (16%) and five (26%) met LVEF or GLS criteria, respectively, and only one met all three criteria.Conclusions: Whilst capturing reduced global LV systolic function, CTRCD definitions are insensitive to meaningful declines in VO2peak and cardiac reserve. Incorporating measures of VO2peak into CTRCD surveillance may improve HF risk stratification in breast cancer survivors.