Left ventricular and cardiac autonomic function in survivors of testicular cancer.
BACKGROUND
Following cisplatin-based chemotherapy, survivors of testicular cancer have a high prevalence of cardiovascular risk factors and an increased risk of cardiovascular disease. Cardiac function has not been extensively studied and no comparisons have been made with men from the general population.


METHODS
Left ventricular and cardiac autonomic function were evaluated in chemotherapy-treated testicular cancer patients, in stage I patients after orchidectomy only, and in healthy men using Doppler echocardiography [wall motion score index, peak early (E) and atrial filling (A) velocities across the mitral valve, E/A-ratio, isovolumetric relaxation time, and deceleration time of the early peak flow] and measurements of N-terminal pro-brain natriuretic peptide and baroreflex sensitivity. Furthermore, 24-h ambulatory blood pressure was measured.


RESULTS
Ninety chemotherapy-treated patients (median age 37 years, range 20-65; median follow up of 7 years, range 3-13) were compared with 44 stage I patients (median age 36 years, range 24-63) and 47 healthy controls (median age 37 years, range 22-55). Wall motion score index was less than 1.5 in all participants. Chemotherapy-treated patients had a higher peak A-wave and a lower E/A-ratio than stage I patients and controls. Isovolumetric relaxation and deceleration times did not differ between groups. Age, 24-h diastolic blood pressure and treatment with chemotherapy were significantly associated with E/A-ratio. Natriuretic peptide levels were normal. Baroreflex sensitivity was similar in the three groups.


CONCLUSIONS
Chemotherapy-treated testicular cancer survivors have a lower E/A-ratio than healthy subjects from the general population, which may indicate impaired relaxation of the left ventricle and reflect the high prevalence of cardiovascular risk factors previously reported in these men.
Nuver
J
J
Department of Medical Oncology, University Hospital Groningen, Hanzaplein, 9700 RB Groningen, the Netherlands.
Smit
A J
AJ
Sleijfer
D T
DT
van Gessel
A I
AI
van Roon
A M
AM
van der Meer
J
J
van den Berg
M P
MP
Hoekstra
H J
HJ
Sluiter
W J
WJ
Gietema
J A
JA
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001342:Autonomic Nervous System Diseases / Q000139:chemically induced* / Q000503:physiopathology; D017704:Baroreflex; D001761:Bleomycin / Q000008:administration & dosage; D001794:Blood Pressure / Q000502:physiology; D009202:Cardiomyopathies / Q000139:chemically induced* / Q000503:physiopathology; D002945:Cisplatin / Q000008:administration & dosage / Q000009:adverse effects; D015150:Echocardiography, Doppler; D005047:Etoposide / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D009919:Orchiectomy / Q000379:methods; D013736:Testicular Neoplasms / Q000188:drug therapy* / Q000601:surgery; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000503:physiopathology
D000970:Antineoplastic Agents; D001761:Bleomycin; D005047:Etoposide; D002945:Cisplatin