title: Early and late changes in markers of aortic stiffness with breast cancer therapy.
abstract: BACKGROUND
  Anthracyclines and trastuzumab are well recognised to cause cardiac toxicity. Further to their effects on left ventricular (LV) function, anthracyclines in particular are considered to cause negative arterial remodelling. Whether these changes reverse is unknown. In addition, whether trastuzumab causes specific effects on arterial remodelling is yet undetermined.
  
  
  METHODS
  Patients receiving these agents for treatment of breast cancer and healthy volunteers prospectively underwent clinical evaluation and cardiovascular magnetic resonance (CMR) imaging at baseline, 1, 4 and 14 months post-therapy, including functional assessment, measurement of aortic pulse wave velocity (PWV) using velocity encoded imaging and distensibility at ascending aorta (AA) and proximal descending aorta (PDA).
  
  
  RESULTS
  Twenty-nine patients pretherapy and 12 volunteers demonstrated no differences in PWV, distensibility and LV function. Among cancer subjects, PWV increased acutely, P = 0.002 (4 months), then decreased by 14 months (P < 0.001). In addition, a decrease was observed in distensibility at the AA within 1 (P = 0.001) and 4 months (P < 0.001) of commencing therapy. At the PDA, only significant reduction was observed at 14 month distensibility when compared with baseline, P < 0.001. Patients with anthracycline exposure only had a greater reduction in aortic distensibility in the AA with time, P = 0.005 at 1 month, P < 0.001 at 4 months and P = 0.009 at 14 months.
  
  
  CONCLUSIONS
  Acute changes are observed in PWV and distensibility at the AA following contemporary breast cancer chemotherapy and partially reverse a year after therapy is discontinued, with more severe effects seen with anthracyclines.
authors.affiliation: Cardiology Department, Flinders Medical Centre, Adelaide, South Australia, Australia; Flinders Cardiac Cardiovascular Magnetic Resonance Department, Flinders Medical Centre, Adelaide, South Australia, Australia; Health Sciences, Flinders University, Adelaide, South Australia, Australia; Heart Health, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Grover
authors.forename: P W
authors.initials: PW
authors.lastname: Lou
authors.forename: C
authors.initials: C
authors.lastname: Bradbrook
authors.forename: K
authors.initials: K
authors.lastname: Cheong
authors.forename: D
authors.initials: D
authors.lastname: Kotasek
authors.forename: D P
authors.initials: DP
authors.lastname: Leong
authors.forename: B
authors.initials: B
authors.lastname: Koczwara
authors.forename: J B
authors.initials: JB
authors.lastname: Selvanayagam
mesh_terms: D000328:Adult; D000368:Aged; D018943:Anthracyclines / Q000008:administration & dosage / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects*; D015415:Biomarkers / Q000032:analysis; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000175:diagnosis; D016022:Case-Control Studies; D004305:Dose-Response Relationship, Drug; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008875:Middle Aged; D015588:Observer Variation; D063177:Pulse Wave Analysis; D012016:Reference Values; D015203:Reproducibility of Results; D018570:Risk Assessment; D013997:Time Factors; D000068878:Trastuzumab; D016896:Treatment Outcome; D059289:Vascular Stiffness / Q000187:drug effects*
chemical_list: D018943:Anthracyclines; D061067:Antibodies, Monoclonal, Humanized; D015415:Biomarkers; D000068878:Trastuzumab
keywords: anthracyclines; aortic distensibility; cardiotoxicity; chemotherapy; pulse wave velocity; trastuzumab