Protective effects of acute exercise prior to doxorubicin on cardiac function of breast cancer patients: A proof-of-concept RCT
Stöhr, Eric J.
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Background: Preclinical studies have reported that a single treadmill session performed 24 h prior to doxorubicin provides cardio-protection. We aimed to characterize the acute change in cardiac function following an initial doxorubicin treatment in humans and determine whether an exercise session performed 24 h prior to treatment changes this response. Methods: Breast cancer patients were randomized to either 30 minutes of vigorous-intensity exercise 24 h prior to the first doxorubicin treatment (n=13), or no vigorous exercise for 72 h prior to treatment (control, n=11). Echocardiographically-derived left ventricular volumes, longitudinal strain, twist, E/A ratio, and circulating NT-proBNP, a marker of later cardiotoxicity, were measured before and 24-48 h after the treatment. Results: Following treatment in the control group, NT-proBNP, end-diastolic and stroke volumes, cardiac output, E/A ratio, strain, diastolic strain rate, twist, and untwist velocity significantly increased (all p≤0.01). Whereas systemic vascular resistance (p<0.01) decreased, and ejection fraction (p=0.02) and systolic strain rate (p<0.01) increased in the exercise group only. Relative to control, the exercise group had a significantly lower NT-proBNP (p<0.01) and a 46% risk reduction of exceeding the cut-point used to exclude acute heart failure. Conclusion: The first doxorubicin treatment is associated with acutely increased NT-proBNP, echocardiographic parameters of myocardial relaxation, left ventricular volume overload, and changes in longitudinal strain and twist opposite in direction to documented longer-term changes. An exercise session performed 24 h prior to treatment attenuated NT-proBNP release and increased systolic function. Future investigations should verify these findings in a larger cohort and across multiple courses of doxorubicin.
International Journal of Cardiology;
Kirkham, A. A., Shave, R. E., Bland, K. A., Bovard, J. M., Eves, N. D., Gelmon, K. A., McKenzie, D.C., Virani, S.A., Stöhr, E.J., Warburton, D.E.R. and Campbell, K. L. (2017) 'Protective effects of acute exercise prior to doxorubicin on cardiac function of breast cancer patients: A proof-of-concept RCT' International Journal of Cardiology (in press)
This article was published in International Journal of Cardiology on 14 July 2017 (online), available at http://dx.doi.org/10.1016/j.ijcard.2017.07.037
Cardiff Metropolitan University (Grant ID: Cardiff Metropolian (Internal))
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