Frequency of Left Ventricular End-Diastolic Volume-Mediated Declines in Ejection Fraction in Patients Receiving Potentially Cardiotoxic Cancer Treatment.
We sought to determine the frequency by which decreases in left ventricular (LV) end-diastolic volume (LVEDV) with and without increases in end-systolic volume (LVESV) influenced early cancer treatment-associated declines in LV ejection fraction (LVEF) or LV mass. One hundred twelve consecutively recruited subjects (aged 52 ± 14 years) with cancer underwent blinded cardiovascular magnetic resonance measurements of LV volumes, mass, and LVEF before and 3 months after initiating potentially cardiotoxic chemotherapy (72% of participants received anthracyclines). Twenty-six participants developed important declines in LVEF of >10% or to values <50% at 3 months, in whom 19% versus 60%, respectively, experienced their decline in LVEF due to isolated declines in LVEDV versus an increase in LVESV; participants who dropped their LVEF due to decreases in LVEDV lost more LV mass than those who dropped their LVEF due to an increase in LVESV (p = 0.03). Nearly one fifth of subjects experience marked LVEF declines due to an isolated decline in LVEDV after initiating potentially cardiotoxic chemotherapy. Because reductions in intravascular volume (which could be treated by volume repletion) may account for LVEDV-related declines in LVEF, these data indicate that LV volumes should be reviewed along with LVEF when acquiring imaging studies for cardiotoxicity during the treatment for cancer.
Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, School of Medicine, Winston-Salem, North Carolina; Section of Comparative Medicine, Department of Pathology, Wake Forest University, School of Medicine, Winston-Salem, North Carolina.
Giselle C
GC
Meléndez
Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, School of Medicine, Winston-Salem, North Carolina.
Bunyapon
B
Sukpraphrute
Department of Biostatistical Sciences, Wake Forest University, School of Medicine, Winston-Salem, North Carolina.
Ralph B
RB
D'Agostino
Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, School of Medicine, Winston-Salem, North Carolina.
Jennifer H
JH
Jordan
Department of Hematology and Oncology, Wake Forest University, School of Medicine, Winston-Salem, North Carolina.
Heidi D
HD
Klepin
Department of Hematology and Oncology, Wake Forest University, School of Medicine, Winston-Salem, North Carolina.
Leslie
L
Ellis
Department of Hematology and Oncology, Wake Forest University, School of Medicine, Winston-Salem, North Carolina.
Zanetta
Z
Lamar
Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, School of Medicine, Winston-Salem, North Carolina.
Sujethra
S
Vasu
Department of Hematology and Oncology, Wake Forest University, School of Medicine, Winston-Salem, North Carolina.
Glenn
G
Lesser
Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest University, School of Medicine, Winston-Salem, North Carolina.
Gregory L
GL
Burke
Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest University, School of Medicine, Winston-Salem, North Carolina.
Kathryn E
KE
Weaver
Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, School of Medicine, Winston-Salem, North Carolina.
William O
WO
Ntim
Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, School of Medicine, Winston-Salem, North Carolina; Department of Radiological Sciences, Wake Forest University, School of Medicine, Winston-Salem, North Carolina. Electronic address: ghundley@wakehealth.edu.
W Gregory
WG
Hundley
D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002306:Cardiac Volume / Q000187:drug effects / Q000502:physiology*; D066126:Cardiotoxicity; D003971:Diastole; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000187:drug effects / Q000503:physiopathology*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy*; D011446:Prospective Studies; D013318:Stroke Volume / Q000187:drug effects*; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000187:drug effects*
D000970:Antineoplastic Agents