Ansund Josefin, Mijwel Sara, Bolam Kate A, Altena Renske, Wengström Yvonne, Rullman Eric, Rundqvist Helene
Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden.
Cardiooncology. 2021 Feb 15;7(1):7. doi: 10.1186/s40959-021-00091-1.
Adjuvant systemic breast cancer treatment improves disease specific outcomes, but also presents with cardiac toxicity. In this post-hoc exploratory analysis of the OptiTrain trial, the effects of exercise on cardiotoxicity were monitored by assessing fitness and biomarkers over the intervention and into survivorship. Methods; Women starting chemotherapy were randomized to 16-weeks of resistance and high-intensity interval training (RT-HIIT), moderate-intensity aerobic and high-intensity interval training (AT-HIIT), or usual care (UC). Outcome measures included plasma troponin-T (cTnT), Nt-pro-BNP and peak oxygen uptake (VO), assessed at baseline, post-intervention, and at 1- and 2-years.
For this per-protocol analysis, 88 women met criteria for inclusion. Plasma cTnT increased in all groups post-intervention. At the 1-year follow-up, Nt-pro-BNP was lower in the exercise groups compared to UC. At 2-years there was a drop in VO for patients with high cTnT and Nt-pro-BNP. Fewer patients in the RT-HIIT group fulfilled biomarker risk criteria compared to UC (OR 0.200; 95% CI = 0.055-0.734).
In this cohort, high-intensity exercise was associated with lower levels of NT-proBNP 1-year post-baseline, but not with cTnT directly after treatment completion. This may, together with the preserved VO in patients with low levels of biomarkers, indicate a long-term cardioprotective effect of exercise.
Clinicaltrials. govNCT02522260 , Registered 13th of august 2015 - Retrospectively Registered.
辅助性系统性乳腺癌治疗可改善疾病特异性结局，但也存在心脏毒性。在OptiTrain试验的这项事后探索性分析中，通过在干预期间及进入生存期后评估体能和生物标志物，监测运动对心脏毒性的影响。方法：开始化疗的女性被随机分为接受16周的抗阻和高强度间歇训练（RT-HIIT）、中等强度有氧和高强度间歇训练（AT-HIIT）或常规护理（UC）。结局指标包括血浆肌钙蛋白T（cTnT）、N末端脑钠肽前体（Nt-pro-BNP）和峰值摄氧量（VO₂），在基线、干预后、1年和2年时进行评估。
对于这项符合方案分析，88名女性符合纳入标准。干预后所有组的血浆cTnT均升高。在1年随访时，运动组的Nt-pro-BNP低于常规护理组。在2年时，cTnT和Nt-pro-BNP水平高的患者VO₂下降。与常规护理组相比，RT-HIIT组达到生物标志物风险标准的患者更少（比值比0.200；95%置信区间=0.055-0.734）。
在这个队列中，高强度运动与基线后1年时较低的NT-proBNP水平相关，但与治疗完成后直接测定的cTnT无关。这可能与生物标志物水平低的患者VO₂得以保留一起，表明运动具有长期心脏保护作用。
Clinicaltrials.govNCT02522260，于2015年8月13日注册——回顾性注册。
