乳腺癌化疗后心肺功能持久受损。
Persistent Impairment in Cardiopulmonary Fitness after Breast Cancer Chemotherapy.
机构信息
Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne VIC, AUSTRALIA.
Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, AUSTRALIA.
出版信息
Med Sci Sports Exerc. 2019 Aug;51(8):1573-1581. doi: 10.1249/MSS.0000000000001970.
PURPOSE
Anthracycline chemotherapy (AC) is associated with acute reductions in cardiopulmonary fitness (V˙O2peak). We sought to determine whether changes in V˙O2peak and cardiac function persisted at 12 months post-AC completion, and whether changes in cardiac function explain the heightened long-term heart failure risk.
METHODS
Women with breast cancer scheduled for AC (n = 28) who participated in a nonrandomized trial of exercise training (ET; n = 14) or usual care (UC; n = 14) during AC completed a follow-up evaluation 12 months post-AC completion (16 months from baseline). At baseline, 4 months, and 16 months, participants underwent a resting echocardiogram (left ventricular ejection fraction; global longitudinal strain), a blood sample (troponin; B-type natriuretic peptide), a cardiopulmonary exercise test, and cardiac MRI measures of stroke volume (SV), heart rate, and cardiac output (Qc) at rest and during intense exercise.
RESULTS
Seventeen women (UC, n = 8; ET, n = 9) completed evaluation at baseline, 4 months, and 16 months. At 4 months, AC was associated with 18% and 6% reductions in V˙O2peak in the UC and ET groups, respectively, which persisted at 16 months (UC, -16%; ET, -7%) and was not attenuated by ET (interaction, P = 0.10). Exercise Qc was lower at 16 months compared with baseline and 4 months (P < 0.001), which was due to a blunted augmentation of SV during exercise (P = 0.032; a 14% reduction in peak SV), with no changes in heart rate response. There was a small reduction in resting left ventricular ejection fraction (baseline to 4 months) and global longitudinal strain (between 4 and 16 months) and an increase in troponin (baseline to 4 months), but only exercise Qc was associated with V˙O2peak (R = 0.47, P < 0.01).
CONCLUSION
Marked reductions in V˙O2peak persisted 12 months after anthracycline-based chemotherapy, which was associated with impaired exercise cardiac function.
CLINICAL TRIAL REGISTRATION
ACTRN12616001602415.
目的
蒽环类化疗（AC）会导致心肺功能的急性下降（峰值摄氧量[V˙O2peak]）。我们试图确定在 AC 完成后 12 个月时，V˙O2peak 和心功能的变化是否持续存在，以及心功能的变化是否解释了长期心力衰竭风险的增加。
方法
计划接受 AC（n = 28）的乳腺癌女性患者参加了一项非随机运动训练（ET）试验（n = 14）或 AC 期间的常规护理（UC；n = 14）。在 AC 完成后（从基线开始 16 个月）进行了随访评估（12 个月）。在基线、4 个月和 16 个月时，参与者进行了静息超声心动图（左心室射血分数；整体纵向应变）、血液样本（肌钙蛋白；B 型利钠肽）、心肺运动测试以及心脏 MRI 测量的静息和剧烈运动时的每搏输出量（SV）、心率和心输出量（Qc）。
结果
17 名女性（UC，n = 8；ET，n = 9）完成了基线、4 个月和 16 个月的评估。4 个月时，UC 和 ET 组的 V˙O2peak 分别下降 18%和 6%，这一结果在 16 个月时仍持续存在（UC，-16%；ET，-7%），且运动训练（交互作用，P = 0.10）并未减弱这种下降。与基线和 4 个月相比，16 个月时运动 Qc 降低（P < 0.001），这是由于 SV 在运动时的增加减弱（P = 0.032；峰值 SV 降低 14%），而心率反应没有变化。静息左心室射血分数（从基线到 4 个月）和整体纵向应变（4 个月到 16 个月）略有下降，肌钙蛋白增加（从基线到 4 个月），但只有运动 Qc 与 V˙O2peak 相关（R = 0.47，P < 0.01）。
结论
蒽环类化疗后 12 个月，V˙O2peak 明显下降，与运动时心功能受损有关。
临床试验注册
ACTRN12616001602415。
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