Cardiovascular Function and Predictors of Exercise Capacity in Patients With Colorectal Cancer

• Published in: Journal of the American College of Cardiology Vol. 64; no. 13; pp. 1310 - 1319
• Main Authors: Cramer, Larissa, Hildebrandt, Bert, Kung, Thomas, Wichmann, Kristin, Springer, Jochen, Doehner, Wolfram, Sandek, Anja, Valentova, Miroslava, Stojakovic, Tatjana, Scharnagl, Hubert, Riess, Hanno, Anker, Stefan D., von Haehling, Stephan
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 30.09.2014; Elsevier Limited
• Subjects: Absorptiometry, Photon; Age; Aged; Antineoplastic Agents - therapeutic use; Biomarkers; Body Composition; Cancer therapies; Cardiology; Cardiovascular; cardiovascular function; Cardiovascular System - physiopathology; Chemotherapy; Colorectal cancer; Colorectal Neoplasms - physiopathology; Confidence intervals; Drug therapy; Dyspnea - physiopathology; Echocardiography; Efficiency; Ergometry; Exercise; exercise capacity; Exercise Tolerance - physiology; Fatigue - physiopathology; Female; Fitness equipment; Heart; Heart Failure - physiopathology; Heart Rate; Humans; Male; Middle Aged; Mortality; Oxygen Consumption; Prospective Studies; Quality of life; Regression analysis; Ventricular Function, Left; Germany; CHF; LVM; VE/VCO2; LVEF; LVESV; HRV; VLF; SDNN index; MR-proANP; VO2; cardiovascular function; LVEDV; hsTnT; SDANN; colorectal cancer; MR-proADM; CT-proET; FVC; CRC; VCO2/VO2; SDNN; exercise capacity; hsCRP; FEV1; LF; HF; 5-FU; forced vital capacity; high-sensitivity troponin T; chronic heart failure; high-sensitivity C-reactive protein; VCO 2/VO 2; low frequency; left ventricular ejection fraction; SD of 5-min mean RR intervals; left ventricular end-diastolic volume; heart rate variability; oxygen consumption; respiratory exchange ratio; forced expiratory volume in 1 second; C-terminal pro-endothelin; left ventricular end-systolic volume; VO 2; FEV 1; VE/VCO 2; SD of all normal RR intervals; mean of the SD of normal RR intervals every 5 min; left ventricular mass; ratio of minute ventilation and carbon dioxide output; mid-regional pro-adrenomedulin; mid-regional pro-atrial natriuretic peptide; very low frequency; high frequency; 5-fluorouracil
• ISSN: 0735-1097; 1558-3597; 1558-3597
• DOI: 10.1016/j.jacc.2014.07.948

Patients with colorectal cancer (CRC) often present with dyspnea and fatigue. These are also frequent symptoms in patients with chronic heart failure (CHF). We hypothesized that similar patterns of cardiovascular perturbations are present in CRC and CHF. We prospectively studied 50 patients with CRC, 51 patients with CHF, and 51 control subjects. The CRC group was divided into 2 subgroups: patients who underwent chemotherapy (n = 26) and chemotherapy-naive patients (n = 24). We assessed exercise capacity (spiroergometry), cardiac function (echocardiography), heart rate variability (Holter electrocardiography), body composition (dual-energy x-ray absorptiometry), and blood parameters. Compared with the control arm, the left ventricular ejection fraction (CRC group 59.4%; control group 62.5%) and exercise performance as assessed by peak oxygen consumption (peak VO2) (CRC group 21.8 ml/kg/min; control group 28.0 ml/kg/min) were significantly reduced in CRC patients (both p < 0.02). Markers of heart rate variability were markedly impaired in CRC patients compared with control subjects (all p < 0.008). Compared with the control group, the CRC group also showed reduced lean mass in the legs and higher levels of the endothelium-derived C-terminal-pro-endothelin-1 (both p < 0.02). Major determinants of cardiovascular function were impaired in chemotherapy-treated patients and in the chemotherapy-naive patients, particularly with regard to exercise capacity, left ventricular ejection fraction, lean mass, and heart rate variability (all p < 0.05 vs. control subjects). Some aspects of cardiovascular function are impaired in patients with CRC. More importantly, our findings were evident independently of whether patients were undergoing chemotherapy.