%0 Journal Article
%T Exercise as a diagnostic and therapeutic tool for the prevention of cardiovascular dysfunction in breast cancer patients
%A Andr¨¦ La Gerche
%A Ashley Bigaran
%A Erin J Howden
%A Mark J Haykowsky
%A Rhys Beaudry
%A Sherene Loi
%A Sophie Nightingale
%A Steve Foulkes
%A Steve Fraser
%A Steve Selig
%A Yoland Antill
%J European Journal of Preventive Cardiology
%@ 2047-4881
%D 2019
%R 10.1177/2047487318811181
%X Anthracycline chemotherapy may be associated with decreased cardiac function and functional capacity measured as the peak oxygen uptake during exercise ( V ¡¤ O 2 peak). We sought to determine (a) whether a structured exercise training program would attenuate reductions in V ¡¤ O 2 peak and (b) whether exercise cardiac imaging is a more sensitive marker of cardiac injury than the current standard of care resting left ventricular ejection fraction (LVEF). Twenty-eight patients with early stage breast cancer undergoing anthracycline chemotherapy were able to choose between exercise training (mean£¿¡À£¿SD age 47£¿¡À£¿9 years, n£¿=£¿14) or usual care (mean£¿¡À£¿SD age 53£¿¡À£¿9 years, n£¿=£¿14). Measurements performed before and after anthracycline chemotherapy included cardiopulmonary exercise testing to determine V ¡¤ O 2 peak and functional disability ( V ¡¤ O 2 peak£¿<£¿18£¿ml/min/kg), resting echocardiography (LVEF and global longitudinal strain), cardiac biomarkers (troponin and B-type natriuretic peptide) and exercise cardiac magnetic resonance imaging to determine stroke volume and peak cardiac output. The exercise training group completed 2£¿¡Á£¿60 minute supervised exercise sessions per week. Decreases in V ¡¤ O 2 peak during chemotherapy were attenuated with exercise training (15 vs. 4% reduction, P£¿=£¿0.010) and fewer participants in the exercise training group met the functional disability criteria after anthracycline chemotherapy compared with those in the usual care group (7 vs. 50%, P£¿=£¿0.01). Compared with the baseline, the peak exercise heart rate was higher and the stroke volume was lower after chemotherapy (P£¿=£¿0.003 and P£¿=£¿0.06, respectively). There was a reduction in resting LVEF (from 63£¿¡À£¿5 to 60£¿¡À£¿5%, P£¿=£¿0.002) and an increase in troponin (from 2.9£¿¡À£¿1.3 to 28.5£¿¡À£¿22.4£¿ng/mL, P£¿<£¿0.0001), but no difference was observed between the usual care and exercise training group. The baseline peak cardiac output was the strongest predictor of functional capacity after anthracycline chemotherapy in a model containing age and resting cardiac function (LVEF and global longitudinal strain). The peak exercise cardiac output can identify patients at risk of chemotherapy-induced functional disability, whereas current clinical standards are unhelpful. Functional disability can be prevented with exercise training
%K Exercise
%K survivorship
%K heart failure
%K cardiorespiratory fitness
%K cardiotoxicity
%U https://journals.sagepub.com/doi/full/10.1177/2047487318811181