Abstract
BackgroundApproximately 20% of cancer survivors treated with chemotherapy experience worsening heart failure (HF) symptoms post-cancer treatment. While research has predominantly investigated the role of cardiotoxic treatments, much less attention has focused on other risk factors, such as adiposity. However, emerging data in cancer survivors indicates that adiposity may also impact a variety of cardiovascular outcomes. Methods: In a prospective study of 62 patients diagnosed with cancer followed for 24 months from cancer diagnosis through to survivorship (post-cancer treatment), we ascertained baseline fat depots including intermuscular fat (IMF) of the erector spinae muscles; and pre- and post-cancer treatment left ventricular ejection fraction (LVEF) and HF symptoms at baseline and 24-months, respectively. Linear regression was used to model independent variables in relation to HF symptoms at 24-months.ResultsBaseline IMF and LVEF change over 24-months significantly interacted to predict HF score at 24-months. The highest HF symptom score was observed for participants who experienced high IMF at baseline and a high decline in LVEF over 24-months (HF score = 11.0) versus all other categories of baseline IMF and LVEF change.ConclusionsTogether IMF and LVEF decline may play an important role in the worsening of HF symptoms in cancer survivors. The finding that IMF at cancer diagnosis led to elevated HF scores post-treatment suggests that IMF may be a potential target for intervention studies.
Highlights
20% of cancer survivors treated with chemotherapy experience worsening heart failure (HF) symptoms post-cancer treatment
We observed in a pilot of 14 cancer survivors an association between fat accumulated within the muscle and reduced exercise capacity, which persisted after controlling for left ventricular ejection fraction (LVEF) decline [8]
Due to the biological plausibility that both LVEF decline and specific fat depots could contribute to HF symptomology, we sought to investigate the relationship between change in patient HF score with change in EF over 24 months and baseline intermuscular fat (IMF) fat
Summary
20% of cancer survivors treated with chemotherapy experience worsening heart failure (HF) symptoms post-cancer treatment. Heart failure (HF) symptoms, such as activity limitations and reduced exercise capacity, worsen after cancer treatment in approximately 20% of chemotherapy-treated patients [1]. Investigations of specific depots of fat (2021) 7:16 may improve the assessment of risk of cardiovascular outcomes in breast cancer beyond BMI [4, 5], an imprecise measure for body adiposity in cancer survivors [6, 7]. Our group investigated fat depots in relation to reduced exercise capacity in cancer survivors, a component of HF symptomology. Due to the biological plausibility that both LVEF decline and specific fat depots could contribute to HF symptomology, we sought to investigate the relationship between change in patient HF score with change in EF over 24 months and baseline IMF fat
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