Left Ventricular Mass Change After Anthracycline Chemotherapy

Area of Science:

• Cardiology
• Oncology
• Cardio-oncology

Background:

• Myocardial atrophy and reduced left ventricular (LV) mass are linked to fatigue and exercise intolerance.
• The impact of anthracycline-based chemotherapy (Anth-bC) on LV mass and heart failure (HF) symptoms is not well understood.
• The relationship between Anth-bC, LV mass changes, and LV ejection fraction (LVEF) in HF surveillance is unknown.

Purpose of the Study:

• To investigate the effects of Anth-bC on LV mass, LVEF, and HF symptomatology.
• To determine if changes in LV mass or LVEF are associated with HF symptoms after Anth-bC.
• To explore the role of LV-arterial coupling and aortic stiffness in Anth-bC-induced cardiac changes.

Main Methods:

• Serial assessments of body weight, LVEF, LV mass, LV-arterial coupling, and aortic stiffness were conducted.
• The Minnesota Living with Heart Failure Questionnaire was used to evaluate HF symptoms.
• Comparisons were made between patients receiving Anth-bC, non-Anth-bC, and cancer-free controls.

Main Results:

• Anth-bC recipients showed a 5% decline in LVEF and LV mass, increased aortic stiffness, and disrupted ventricular-arterial coupling.
• Worsening HF symptoms, measured by the Minnesota Living with Heart Failure Questionnaire, correlated with LV mass declines but not LVEF declines.
• These associations were independent of LVEF changes and body weight.

Conclusions:

• Reductions in LV mass following Anth-bC are associated with worsening HF symptoms, independent of LVEF.
• Anthracyclines may contribute to HF symptomatology through mechanisms beyond LVEF reduction.
• Current surveillance strategies for Anth-bC-treated patients may benefit from including LV mass assessment.