Larissa Cramer1, Bert Hildebrandt2, Thomas Kung1, Kristin Wichmann1, Jochen Springer3, Wolfram Doehner4, Anja Sandek1, Miroslava Valentova5, Tatjana Stojakovic6, Hubert Scharnagl6, Hanno Riess2, Stefan D Anker7, Stephan von Haehling8. 1. Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany. 2. Department of Hematology and Oncology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany. 3. Department of Innovative Clinical Trials, University Medical Centre Göttingen, Göttingen, Germany; Department of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany. 4. Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany; Center for Stroke Research CSB, Charité Medical School, Berlin, Germany. 5. Department of Innovative Clinical Trials, University Medical Centre Göttingen, Göttingen, Germany; 1st Department of Internal Medicine, Faculty Hospital, Bratislava, Slovak Republic. 6. Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria. 7. Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany; Department of Innovative Clinical Trials, University Medical Centre Göttingen, Göttingen, Germany. 8. Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany; Department of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany. Electronic address: stephan.von.haehling@web.de.
Abstract
BACKGROUND: Patients with colorectal cancer (CRC) often present with dyspnea and fatigue. These are also frequent symptoms in patients with chronic heart failure (CHF). OBJECTIVES: We hypothesized that similar patterns of cardiovascular perturbations are present in CRC and CHF. METHODS: We prospectively studied 50 patients with CRC, 51 patients with CHF, and 51 control subjects. The CRC group was divided into 2 subgroups: patients who underwent chemotherapy (n = 26) and chemotherapy-naive patients (n = 24). We assessed exercise capacity (spiroergometry), cardiac function (echocardiography), heart rate variability (Holter electrocardiography), body composition (dual-energy x-ray absorptiometry), and blood parameters. RESULTS: Compared with the control arm, the left ventricular ejection fraction (CRC group 59.4%; control group 62.5%) and exercise performance as assessed by peak oxygen consumption (peak VO2) (CRC group 21.8 ml/kg/min; control group 28.0 ml/kg/min) were significantly reduced in CRC patients (both p < 0.02). Markers of heart rate variability were markedly impaired in CRC patients compared with control subjects (all p < 0.008). Compared with the control group, the CRC group also showed reduced lean mass in the legs and higher levels of the endothelium-derived C-terminal-pro-endothelin-1 (both p < 0.02). Major determinants of cardiovascular function were impaired in chemotherapy-treated patients and in the chemotherapy-naive patients, particularly with regard to exercise capacity, left ventricular ejection fraction, lean mass, and heart rate variability (all p < 0.05 vs. control subjects). CONCLUSIONS: Some aspects of cardiovascular function are impaired in patients with CRC. More importantly, our findings were evident independently of whether patients were undergoing chemotherapy.
BACKGROUND:Patients with colorectal cancer (CRC) often present with dyspnea and fatigue. These are also frequent symptoms in patients with chronic heart failure (CHF). OBJECTIVES: We hypothesized that similar patterns of cardiovascular perturbations are present in CRC and CHF. METHODS: We prospectively studied 50 patients with CRC, 51 patients with CHF, and 51 control subjects. The CRC group was divided into 2 subgroups: patients who underwent chemotherapy (n = 26) and chemotherapy-naive patients (n = 24). We assessed exercise capacity (spiroergometry), cardiac function (echocardiography), heart rate variability (Holter electrocardiography), body composition (dual-energy x-ray absorptiometry), and blood parameters. RESULTS: Compared with the control arm, the left ventricular ejection fraction (CRC group 59.4%; control group 62.5%) and exercise performance as assessed by peak oxygen consumption (peak VO2) (CRC group 21.8 ml/kg/min; control group 28.0 ml/kg/min) were significantly reduced in CRC patients (both p < 0.02). Markers of heart rate variability were markedly impaired in CRC patients compared with control subjects (all p < 0.008). Compared with the control group, the CRC group also showed reduced lean mass in the legs and higher levels of the endothelium-derived C-terminal-pro-endothelin-1 (both p < 0.02). Major determinants of cardiovascular function were impaired in chemotherapy-treated patients and in the chemotherapy-naive patients, particularly with regard to exercise capacity, left ventricular ejection fraction, lean mass, and heart rate variability (all p < 0.05 vs. control subjects). CONCLUSIONS: Some aspects of cardiovascular function are impaired in patients with CRC. More importantly, our findings were evident independently of whether patients were undergoing chemotherapy.
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