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Numerous cancer therapies may contribute to the cumulative risk for heart disease, including chemotherapeutic agents such as anthracyclines and targeted therapies such as the HER2 inhibitor trastuzumab. These therapies are effective treatments for breast cancer, so they continue to be used at doses considered to be low risk and worth the tradeoff for their therapeutic benefit.
Cardio-oncology programs have been developed as collaborations between cardiology and oncology clinicians in an effort to better understand how cardiovascular complications develop for cancer patients, improve detection, and determine how they can be effectively avoided or treated.
Cardiac imaging in cardio-oncology programs has been exclusively performed by echocardiography or nuclear medicine imaging and focused on the left ventricle. Heart atrophy is common in cancer patients based on postmortem measurement, and more specifically in cancer cachexia, and girls who received anthracycline therapy in childhood cancers were at high risk for developing reduced cardiac mass.
Breast cancer patients treated with anthracycline and trastuzumab therapy had reductions in ejection fraction in both the LV and RV and reduced LV mass normalized to body surface area. Importantly, these patients had normal body weights and do not represent the extreme catabolic presentations found in cancer patients with severe cachexia. Our findings that these patients still had reduced mass may be part of a systemic loss of muscle mass in cancer patients that could be masked due to muscle replacement with adipose tissue, or a specific vulnerability of the heart to atrophy.
These results demonstrate that combination chemotherapy in female patients produces cardiac atrophy and biventricular systolic dysfunction, even with normal BMIs and modest chemotherapy use. The unknown long-term consequences of reduced heart mass and biventricular dysfunction in surviving cancer patients warrant careful attention.
The full text of this research letter can be accessed via the Source information below.
Primary Source
Journal of the American College of Cardiology
McLean BA, et al "Breast cancer patients receiving anthracycline chemotherapy and trastuzumab have biventricular dysfunction and reduced heart mass" JACC 2018; 72(15): 1872-1873.