title: Non-invasive assessment of cardiac hemodynamics in patients with advanced cancer and with chronic heart failure: a pilot feasibility study.
abstract: BACKGROUND
  Relationships between cardiac pressure and volume have been suggested as markers of cardiac contractility; parameters include stroke work and the maximal rate of pressure rise during isovolumic contraction (dP/dtmax). Patients with cancer often display dyspnea and fatigue. These are also frequent symptoms in patients with chronic heart failure (HF). The reasons for similar symptoms in cancer patients are unknown. Using the novel Nexfin Finapres technique, we sought to assess measures of cardiac performance in patients with cancer and compare these values with those from control subjects and patients with chronic HF.
  
  
  METHODS
  We prospectively studied 98 patients (control n = 18, chronic HF n = 37, advanced pancreatic or colorectal cancer n = 43) and assessed blood pressure (BP), stroke volume (SV), cardiac output (CO), and dP/dtmax at rest.
  
  
  RESULTS
  All parameters of interest could be assessed using the Nexfin Finapres technique with SV and CO being significantly higher in patients with cancer than in controls (both p < 0.05). The SV was significantly higher in patients with chronic HF than in controls (p < 0.05). In patients with cancer, SV correlated with age (r = -0.45, p < 0.01) and body weight (r = +0.55, p = 0.0001). In chronic HF, SV declined with increasing age (r = -0.49, p < 0.01); in control subjects, SV increased with increasing body weight (r = +0.57, p = 0.01).
  
  
  CONCLUSIONS
  Patients with cancer tended to display elevated BP, CO, SV, and dP/dtmax as compared to control subjects and patients with HF. These findings may reveal an elevated risk for cardiovascular diseases in this group.
authors.affiliation: Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany ; Center for Cardiovascular Research (CCR), Charité Medical School, Campus Mitte, Berlin, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: von Haehling
authors.forename: Mitja
authors.initials: M
authors.lastname: Lainscak
authors.forename: Thomas
authors.initials: T
authors.lastname: Kung
authors.forename: Larissa
authors.initials: L
authors.lastname: Cramer
authors.forename: Susann
authors.initials: S
authors.lastname: Fülster
authors.forename: Uwe
authors.initials: U
authors.lastname: Pelzer
authors.forename: Bert
authors.initials: B
authors.lastname: Hildebrandt
authors.forename: Anja
authors.initials: A
authors.lastname: Sandek
authors.forename: Joerg C
authors.initials: JC
authors.lastname: Schefold
authors.forename: Mathias
authors.initials: M
authors.lastname: Rauchhaus
authors.forename: Wolfram
authors.initials: W
authors.lastname: Doehner
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
keywords: cancer; cardiac output; heart failure; hemodynamics; stroke volume