Abstract 11980: Patients With Esophageal Cancer Show Reduction in Myocardial Function and Reduced Oxygen Consumption During Exercise After Chemo-Radiotherapy

Abstract

Introduction: Chemo-radiotherapy (CRT) may induce myocardial dysfunction, congestive heart failure and impaired physical performance in patients with esophageal cancer (EC). We aimed to investigate left ventricular function at rest and at peak exercise using echocardiography (ECHO) before and after completed CRT. Material and Methods: We enrolled 47 EC patients, referred to curative CRT, (41.4-50 Gy in 23-28 fractions and carboplatin, paclitaxel) followed by surgery (nCRT), n=38 or CRT, n=9. Evaluation included myocardial function, physical performance, cardiac biomarkers, electrocardiogram, ECHO at rest and during stress, and by cardiopulmonary exercise test before and post CRT. The primary endpoint was changes in LV global longitudinal strain (GLS). Secondary endpoints were LVEF, LV diastolic function, LVEF and GLS at peak exercise and maximal oxygen consumption. Results: Median age was 67 years, 94% males. The median time to post CRT follow-up was 1 day (IQR 0,6). There was a significant drop in LVEF and GLS at rest 56.7 % vs. 53.8% and 17.6 % vs. 16.4%, respectively (p=0.03; p=0.004). Ten patients had an absolute fall of at least 5% in LVEF and 2.5% in GLS. Signs of LV diastolic dysfunction increased from 13% to 21%, p=ns. Peak VO2 and maximal work capacity significantly decreased 21.2 vs. 18.8 and 5.9 vs. 5.4 respectively (p =0.000 and p=0.000). We found a weak correlation between change in GLS at peak exercise and fall in VO2 max (r=0.369 p=0.018). Conclusion: Left ventricular function and physical performance decreased in patients with EC after completed CRT. The decrease of peak V02 performance was only weakly significant related to the changes of peak LV function which indicates that other factors are involved in the decline of the physical performance after CRT. Keywords Esophageal cancer, chemoradiotherapy, cardiac function, working capacity, cardiotoxicity.