title: Cardiac dysfunction in cancer survivors unmasked during exercise.
abstract: BACKGROUND
  The cardiac dysfunction associated with anthracycline-based chemotherapy cancer treatment can exist subclinically for decades before overt presentation. Stress echocardiography, the measurement of left ventricular (LV) deformation and arterial haemodynamic evaluation, has separately been used to identify subclinical cardiovascular (CV) dysfunction in several patient groups including those with hypertension and diabetes. The purpose of the present cross-sectional study was to determine whether the combination of these techniques could be used to improve the characterisation of subclinical CV dysfunction in long-term cancer survivors previously treated with anthracyclines.
  
  
  METHODS
  Thirteen long-term cancer survivors (36 ± 10 years) with prior anthracycline exposure (11 ± 8 years posttreatment) and 13 age-matched controls were recruited. Left ventricular structure, function and deformation were assessed using echocardiography. Augmentation index was used to quantify arterial haemodynamic load and was measured using applanation tonometry. Measurements were taken at rest and during two stages of low-intensity incremental cycling.
  
  
  RESULTS
  At rest, both groups had comparable global LV systolic, diastolic and arterial function (all P > 0·05); however, longitudinal deformation was significantly lower in cancer survivors (-18 ± 2 vs. -20 ± 2, P < 0·05). During exercise, this difference between groups persisted and further differences were uncovered with significantly lower apical circumferential deformation in the cancer survivors (-24 ± 5 vs. -29 ± 5, -29 ± 5 vs. 35 ± 8 for first and second stage of exercise respectively, both P < 0·05).
  
  
  CONCLUSIONS
  In contrast to resting echocardiography, the measurement of LV deformation at rest and during exercise provides a more comprehensive characterisation of subclinical LV dysfunction. Larger studies are required to determine the clinical relevance of these preliminary findings.
authors.affiliation: Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, UK.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Kearney
authors.affiliation: Velindre Cancer Centre, Cardiff, UK.
authors.forename: Eve
authors.initials: E
authors.lastname: Gallop-Evans
authors.affiliation: Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, UK.|Wales Heart Research Institute, Cardiff University School of Medicine, Cardiff, UK.
authors.forename: John R
authors.initials: JR
authors.lastname: Cockcroft
authors.affiliation: Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, UK.
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Stöhr
authors.affiliation: Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, UK.|University Hospital Wales, Cardiff, UK.
authors.forename: Eveline
authors.initials: E
authors.lastname: Lee
authors.affiliation: Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, UK.
authors.forename: Karianne
authors.initials: K
authors.lastname: Backx
authors.affiliation: College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Haykowsky
authors.affiliation: Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, UK.|University Hospital Wales, Cardiff, UK.
authors.forename: Zaheer
authors.initials: Z
authors.lastname: Yousef
authors.affiliation: Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, UK.|Wales Heart Research Institute, Cardiff University School of Medicine, Cardiff, UK.
authors.forename: Rob
authors.initials: R
authors.lastname: Shave
mesh_terms: D000293:Adolescent; D000328:Adult; D018943:Anthracyclines / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000009:adverse effects*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004452:Echocardiography; D025401:Echocardiography, Stress; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D017741:Survivors; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D055815:Young Adult
chemical_list: D018943:Anthracyclines; D000970:Antineoplastic Agents
keywords: Anthracyclines; arterial haemodynamics; cardiac deformation; exercise echocardiography