背景:在癌症幸存者中,心肺功能(CRF)降低,并预测心血管疾病(CVD)相关和全因死亡率。然而,CRF的常规测量并不总是可行的。
目的:本研究的目的是确定临床,心脏生物标志物,和与降低峰值耗氧量(VO2peak)(CRF测量)相关的影像学测量,以帮助告知早期乳腺癌治疗后CVD风险。
方法:前瞻性招募接受蒽环类药物和曲妥珠单抗治疗的早期HER2+乳腺癌患者。曲妥珠单抗完成后6±2周内,我们收集了临床信息,收缩/舒张超声心动图测量,高灵敏度肌钙蛋白I,B型利钠肽,和VO2peak使用循环测力计。回归模型用于检查VO2peak与临床之间的关联,成像,和心脏生物标志物单独和组合。
结果:在147名患者(年龄52.2±9.3岁)中,平均VO2峰为19.1±5.0mLO2·kg-1·min-1(预测值的84.2%±18.7%);44%的VO2峰低于功能独立性阈值(<18mLO2·kg-1·min-1)。在多变量分析中,绝对整体纵向应变(GLS)(β=0.58;P=0.007),每10岁(β:-1.61;P=0.001),和E/e'(舒张压测量)(β=-0.45;P=0.038)与VO2峰相关。GLS在解释VO2peak的可变性方面增加了增量价值。年龄≥50岁的组合,E/e≥7.8,GLS<18%,发现功能独立性受损的可能性很高(85.7%),而年龄<50岁,E/e<7.8,GLS≥18%的概率较低(0%)。高敏肌钙蛋白I和B型利钠肽与VO2峰无关。
结论:易于获得的临床措施与VO2峰值早期乳腺癌治疗相关。这些参数的组合对识别功能独立性受损并可能增加未来CVD风险的患者具有良好的区分度。
BACKGROUND: Cardiorespiratory fitness (CRF) is reduced in cancer survivors and predicts cardiovascular disease (CVD)-related and all-cause mortality. However, routine measurement of CRF is not always feasible.
OBJECTIVE: The purpose of this study was to identify clinical, cardiac biomarker, and imaging measures associated with reduced peak oxygen consumption (VO2peak) (measure of CRF) early post-breast cancer therapy to help inform CVD risk.
METHODS: Consecutive women with early-stage HER2+ breast cancer receiving anthracyclines and trastuzumab were recruited prospectively. Within 6 ± 2 weeks of trastuzumab completion, we collected clinical information, systolic/diastolic echocardiographic measures, high-sensitivity troponin I, B-type natriuretic peptide, and VO2peak using a cycle ergometer. Regression models were used to examine the association between VO2peak and clinical, imaging, and cardiac biomarkers individually and in combination.
RESULTS: Among 147 patients (age 52.2 ± 9.3 years), the mean VO2peak was 19.1 ± 5.0 mL O2·kg-1·min-1 (84.2% ± 18.7% of predicted); 44% had a VO2peak below threshold for functional independence (<18 mL O2·kg-1·min-1). In multivariable analysis, absolute global longitudinal strain (GLS) (β = 0.58; P = 0.007), age per 10 years (β: -1.61; P = 0.001), and E/e\' (measure of diastolic filling pressures) (β = -0.45; P = 0.038) were associated with VO2peak. GLS added incremental value in explaining the variability in VO2peak. The combination of age ≥50 years, E/e\' ≥7.8, and GLS <18% identified a high probability (85.7%) of compromised functional independence, whereas age <50 years, E/e\' <7.8, and GLS ≥18% identified a low probability (0%). High-sensitivity troponin I and B-type natriuretic peptide were not associated with VO2peak.
CONCLUSIONS: Readily available clinical measures were associated with VO2peak early post-breast cancer therapy. A combination of these parameters had good discrimination to identify patients with compromised functional independence and potentially increased future CVD risk.