Cardiovascular phenotype and prognosis of patients with heart failure induced by cancer therapy

被引:26
作者
Nadruz, Wilson [1 ,2 ]
West, Erin [1 ]
Sengelov, Morten [1 ]
Grove, Gabriela L. [1 ]
Santos, Mario [3 ]
Groarke, John D. [1 ]
Forman, Daniel E. [4 ,5 ]
Claggett, Brian [1 ]
Skali, Hicham [1 ]
Nohria, Anju [1 ]
Shah, Amil M. [1 ]
机构
[1] Brigham & Womens Hosp, Div Cardiovasc Med, Boston, MA 02445 USA
[2] Univ Estadual Campinas, Dept Internal Med, Campinas, SP, Brazil
[3] Univ Porto, Fac Med, Porto, Portugal
[4] Univ Pittsburgh, Med Ctr, Dept Cardiol, Pittsburgh, PA USA
[5] VA Pittsburgh Healthcare Syst, Pittsburgh, PA USA
关键词
heart failure; cancer; strain; cardiopulmonary exercise testing; diastolic function; CHEMOTHERAPY-INDUCED CARDIOMYOPATHY; PRESERVED EJECTION FRACTION; CARDIAC STRUCTURE; ASSOCIATION; OUTCOMES; SURVIVAL; RISK; ECHOCARDIOGRAPHY; RADIOTHERAPY; DYSFUNCTION;
D O I
10.1136/heartjnl-2018-313234
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective This study compared the clinical features, cardiac structure and function evaluated by echocardiography, cardiopulmonary response to exercise and long-term clinical outcomes between patients with heart failure (HF) induced by cancer therapy (CTHF) and heart failure not induced by cancer therapy (NCTHF). Methods We evaluated 75 patients with CTHF and 894 with NCTHF who underwent clinically indicated cardiopulmonary exercise testing, and followed these individuals for a median of 4.5 (3.0-5.8) years, during which 187 deaths and 256 composite events (death, heart transplantation and left ventricular (LV) assistant device implantation) occurred. Results Compared with NCTHF, patients with CTHF were younger, with lower prevalence of cardiovascular comorbidities, higher LV ejection fraction (LVEF), but similar global longitudinal strain. LV diastolic function (higher E/e ' ratio) and compliance (higher end-diastolic pressure/LV end-diastolic volume index ratio) were worse in CTHF and were both associated with adverse outcomes. Despite a favourable clinical profile, peak VO2 and VE/VCO2 slope were similarly impaired in CTHF and NCTHF. In multivariable Cox regression analysis including clinical characteristics, cardiopulmonary exercise testing variables and LVEF, CTHF was associated with a significantly higher risk of death (HR 2.64; 95% CI 1.53 to 4.55; p=0.001) and composite events (HR 1.79; 95% CI 1.10 to 2.91; p=0.019) compared with NCTHF. Conclusions CTHF is characterised by a distinct clinical profile, better LVEF but worse LV diastolic properties, and similarly impaired global longitudinal strain, functional capacity and ventilatory efficiency. Accounting for differences in clinical characteristics, CTHF was associated with worse long-term prognosis than NCTHF.
引用
收藏
页码:34 / 41
页数:8
相关论文
共 30 条
[1]   Comprehensive Echocardiographic Detection of Treatment-Related Cardiac Dysfunction in Adult Survivors of Childhood Cancer [J].
Armstrong, Gregory T. ;
Joshi, Vijaya M. ;
Ness, Kirsten K. ;
Marwick, Thomas H. ;
Zhang, Nan ;
Srivastava, DeoKumar ;
Griffin, Brian P. ;
Grimm, Richard A. ;
Thomas, James ;
Phelan, Dermot ;
Collier, Patrick ;
Krull, Kevin R. ;
Mulrooney, Daniel A. ;
Green, Daniel M. ;
Hudson, Melissa M. ;
Robison, Leslie L. ;
Plana, Juan Carlos .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2015, 65 (23) :2511-2522
[2]  
ASTRAND I, 1960, Acta Physiol Scand Suppl, V49, P1
[3]   Chronotropic Incompetence Causes, Consequences, and Management [J].
Brubaker, Peter H. ;
Kitzman, Dalane W. .
CIRCULATION, 2011, 123 (09) :1010-1020
[4]   Prognostic Importance of Pathophysiologic Markers in Patients With Heart Failure and Preserved Ejection Fraction [J].
Burke, Michael A. ;
Katz, Daniel H. ;
Beussink, Lauren ;
Selvaraj, Senthil ;
Gupta, Deepak K. ;
Fox, Justin ;
Chakrabarti, Sudarsana ;
Sauer, Andrew J. ;
Rich, Jonathan D. ;
Freed, Benjamin H. ;
Shah, Sanjiv J. .
CIRCULATION-HEART FAILURE, 2014, 7 (02) :288-299
[5]   Association of Heart Rate and Outcomes in a Broad Spectrum of Patients With Chronic Heart Failure [J].
Castagno, Davide ;
Skali, Hicham ;
Takeuchi, Madoka ;
Swedberg, Karl ;
Yusuf, Salim ;
Granger, Christopher B. ;
Michelson, Eric L. ;
Pfeffer, Marc A. ;
McMurray, John J. V. ;
Solomon, Scott D. .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2012, 59 (20) :1785-+
[6]   Risk of Ischemic Heart Disease in Women after Radiotherapy for Breast Cancer [J].
Darby, Sarah C. ;
Ewertz, Marianne ;
McGale, Paul ;
Bennet, Anna M. ;
Blom-Goldman, Ulla ;
Bronnum, Dorthe ;
Correa, Candace ;
Cutter, David ;
Gagliardi, Giovanna ;
Gigante, Bruna ;
Jensen, Maj-Britt ;
Nisbet, Andrew ;
Peto, Richard ;
Rahimi, Kazem ;
Taylor, Carolyn ;
Hall, Per .
NEW ENGLAND JOURNAL OF MEDICINE, 2013, 368 (11) :987-998
[7]   Association between resting heart rate, chronotropic index, and long-term outcomes in patients with heart failure receiving -blocker therapy: data from the HF-ACTION trial [J].
Dobre, Daniela ;
Zannad, Faiez ;
Keteyian, Steven J. ;
Stevens, Susanna R. ;
Rossignol, Patrick ;
Kitzman, Dalane W. ;
Landzberg, Joel ;
Howlett, Jonathan ;
Kraus, William E. ;
Ellis, Stephen J. .
EUROPEAN HEART JOURNAL, 2013, 34 (29) :2271-2280
[8]   Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. [J].
Felker, GM ;
Thompson, RE ;
Hare, JM ;
Hruban, RH ;
Clemetson, DE ;
Howard, DL ;
Baughman, KL ;
Kasper, EK .
NEW ENGLAND JOURNAL OF MEDICINE, 2000, 342 (15) :1077-1084
[9]   Abnormal Exercise Response in Long-Term Survivors of Hodgkin Lymphoma Treated With Thoracic Irradiation [J].
Groarke, John D. ;
Tanguturi, Varsha K. ;
Hainer, Jon ;
Klein, Josh ;
Moslehi, Javid J. ;
Ng, Andrea ;
Forman, Daniel E. ;
Di Carli, Marcelo F. ;
Nohria, Anju .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2015, 65 (06) :573-583
[10]   PREDICTED VALUES FOR CLINICAL EXERCISE TESTING [J].
HANSEN, JE ;
SUE, DY ;
WASSERMAN, K .
AMERICAN REVIEW OF RESPIRATORY DISEASE, 1984, 129 (02) :S49-S55