HEART RATE VARIABILITY TRENDS IN PATIENTS RECEIVING A SIX-MONTH COURSE OF BEVACIZUMAB - A CARDIOTOXIC ANTI-CANCER AGENT

Abstract

BackgroundBevacizumab is a humanized monoclonal antibody that inhibits the activity of vascular endothelial growth factor. It has demonstrated activity against several malignancies. Adverse cardiovascular effects that have been reported in association with bevacizumab include hypertension, endothelial dysfunction and heart failure. Animal models have suggested autonomic nervous system (ANS) toxicity as one potential mechanism for these effects. We have previously reported on the acute and short-term effects of this drug and we report on the medium-term effects herein.MethodsPatients were recruited among those beginning bevacizumab for the treatment of metastatic colon cancer. Demographics and clinical characteristics of the patients at the time of enrollment were collected. A 10-minute high-resolution ECG was recorded prior to a first dose of bevacizumab and analysed for heart rate variability (HRV), a marker of ANS dysfunction. Patients returned 6 months after their initial visit and had a repeat 10-minute ECG recording. Paired t-tests were used to compare baseline HRV recordings to those recorded after a 6-month course of the drug.ResultsTen patients without a significant cardiac history were enrolled. Seven patients survived to 6 months of follow up and are included in this analysis. Mean patient age was 64 years and 6 were male. All were in sinus rhythm and had normal systolic function by echocardiography. Changes in HRV indices are reported in Table 1.ConclusionKGH Garfield Kelly Award, KGH/HDH Cardiac Program Award BackgroundBevacizumab is a humanized monoclonal antibody that inhibits the activity of vascular endothelial growth factor. It has demonstrated activity against several malignancies. Adverse cardiovascular effects that have been reported in association with bevacizumab include hypertension, endothelial dysfunction and heart failure. Animal models have suggested autonomic nervous system (ANS) toxicity as one potential mechanism for these effects. We have previously reported on the acute and short-term effects of this drug and we report on the medium-term effects herein. Bevacizumab is a humanized monoclonal antibody that inhibits the activity of vascular endothelial growth factor. It has demonstrated activity against several malignancies. Adverse cardiovascular effects that have been reported in association with bevacizumab include hypertension, endothelial dysfunction and heart failure. Animal models have suggested autonomic nervous system (ANS) toxicity as one potential mechanism for these effects. We have previously reported on the acute and short-term effects of this drug and we report on the medium-term effects herein. MethodsPatients were recruited among those beginning bevacizumab for the treatment of metastatic colon cancer. Demographics and clinical characteristics of the patients at the time of enrollment were collected. A 10-minute high-resolution ECG was recorded prior to a first dose of bevacizumab and analysed for heart rate variability (HRV), a marker of ANS dysfunction. Patients returned 6 months after their initial visit and had a repeat 10-minute ECG recording. Paired t-tests were used to compare baseline HRV recordings to those recorded after a 6-month course of the drug. Patients were recruited among those beginning bevacizumab for the treatment of metastatic colon cancer. Demographics and clinical characteristics of the patients at the time of enrollment were collected. A 10-minute high-resolution ECG was recorded prior to a first dose of bevacizumab and analysed for heart rate variability (HRV), a marker of ANS dysfunction. Patients returned 6 months after their initial visit and had a repeat 10-minute ECG recording. Paired t-tests were used to compare baseline HRV recordings to those recorded after a 6-month course of the drug. ResultsTen patients without a significant cardiac history were enrolled. Seven patients survived to 6 months of follow up and are included in this analysis. Mean patient age was 64 years and 6 were male. All were in sinus rhythm and had normal systolic function by echocardiography. Changes in HRV indices are reported in Table 1. Ten patients without a significant cardiac history were enrolled. Seven patients survived to 6 months of follow up and are included in this analysis. Mean patient age was 64 years and 6 were male. All were in sinus rhythm and had normal systolic function by echocardiography. Changes in HRV indices are reported in Table 1. ConclusionKGH Garfield Kelly Award, KGH/HDH Cardiac Program Award KGH Garfield Kelly Award, KGH/HDH Cardiac Program Award