Heart rate variability-based prediction of early cardiotoxicity in breast-cancer patients treated with anthracyclines and trastuzumab
Abstract Background Cardiotoxicity is a recognized complication in breast cancer (BC) patients undergoing chemotherapy with anthracyclines with or without trastuzumab. However, the prognostic value of heart rate variability (HRV) indexes for early cardiotoxicity development remains unknown. Purpose...
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| Veröffentlicht in: | European heart journal 2024-10, Vol.45 (Supplement_1) |
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| creator | Espinola-Zavaleta, N Luna-Alcala, S Espejel-Guzman, A Lerma, C Leon, P Guerra, E C Espinoza Fernandez, J R Martinez-Dominguez, P Serrano-Roman, J Cabello-Ganem, A Aparicio-Ortiz, A D Keirns, C Lerma, A Santa Ana-Bayona, M J |
| description | Abstract
Background
Cardiotoxicity is a recognized complication in breast cancer (BC) patients undergoing chemotherapy with anthracyclines with or without trastuzumab. However, the prognostic value of heart rate variability (HRV) indexes for early cardiotoxicity development remains unknown.
Purpose
This study aimed to investigate cardiac autonomic responses to physiological stimuli in BC patients treated with anthracyclines with or without trastuzumab, and to evaluate the predictive value of transthoracic echocardiography (TTE) findings and HRV indexes for early cardiotoxicity.
Methods
A prospective cohort study involving 50 BC patients was conducted at a tertiary hospital with TTE assessments performed before and three months after chemotherapy. HRV indexes were obtained from continuous electrocardiograms in supine position with spontaneous breathing, active standing, and supine position with controlled breathing. The magnitude of change (Δ) between supine-standing and supine-controlled breathing was calculated. Variables were compared using t-test or ANOVA. Cardiotoxicity predictive value was assessed by ROC curve analysis. A p value of < 0.05 was considered significant.
Results
In our cohort, the mean age was 50 ± 8 years, and reported comorbidities included diabetes (n= 9), hypertension (n= 17), and dyslipidemia (n= 11). Twenty-three patients fulfilled echocardiographic and troponin cardiotoxicity criteria or both. TTE revealed reduced left atrial conduit strain in the cardiotoxicity group. Mean heart rate increased during all maneuvers at follow-up, with no differences in HRV indexes between patients with or without cardiotoxicity. However, a lower Δ in supine-controlled breathing of several HRV indexes predicted early cardiotoxicity identified by echocardiography (e.g. SDNN ≤ -8.44 ms: Sensitivity = 75%, Specificity = 69%).
Conclusion
BC patients treated with chemotherapy maintain cardiac autonomic responses to physiological stimuli after 3 months of chemotherapy. However, a lower Δ during active standing and controlled breathing before chemotherapy may predict early cardiotoxicity.Table 1.ROC curve analysisFigure 1.HRV-indexes |
| doi_str_mv | 10.1093/eurheartj/ehae666.3199 |
| format | Article |
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Background
Cardiotoxicity is a recognized complication in breast cancer (BC) patients undergoing chemotherapy with anthracyclines with or without trastuzumab. However, the prognostic value of heart rate variability (HRV) indexes for early cardiotoxicity development remains unknown.
Purpose
This study aimed to investigate cardiac autonomic responses to physiological stimuli in BC patients treated with anthracyclines with or without trastuzumab, and to evaluate the predictive value of transthoracic echocardiography (TTE) findings and HRV indexes for early cardiotoxicity.
Methods
A prospective cohort study involving 50 BC patients was conducted at a tertiary hospital with TTE assessments performed before and three months after chemotherapy. HRV indexes were obtained from continuous electrocardiograms in supine position with spontaneous breathing, active standing, and supine position with controlled breathing. The magnitude of change (Δ) between supine-standing and supine-controlled breathing was calculated. Variables were compared using t-test or ANOVA. Cardiotoxicity predictive value was assessed by ROC curve analysis. A p value of < 0.05 was considered significant.
Results
In our cohort, the mean age was 50 ± 8 years, and reported comorbidities included diabetes (n= 9), hypertension (n= 17), and dyslipidemia (n= 11). Twenty-three patients fulfilled echocardiographic and troponin cardiotoxicity criteria or both. TTE revealed reduced left atrial conduit strain in the cardiotoxicity group. Mean heart rate increased during all maneuvers at follow-up, with no differences in HRV indexes between patients with or without cardiotoxicity. However, a lower Δ in supine-controlled breathing of several HRV indexes predicted early cardiotoxicity identified by echocardiography (e.g. SDNN ≤ -8.44 ms: Sensitivity = 75%, Specificity = 69%).
Conclusion
BC patients treated with chemotherapy maintain cardiac autonomic responses to physiological stimuli after 3 months of chemotherapy. However, a lower Δ during active standing and controlled breathing before chemotherapy may predict early cardiotoxicity.Table 1.ROC curve analysisFigure 1.HRV-indexes</description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehae666.3199</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><ispartof>European heart journal, 2024-10, Vol.45 (Supplement_1)</ispartof><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. 2024</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids></links><search><creatorcontrib>Espinola-Zavaleta, N</creatorcontrib><creatorcontrib>Luna-Alcala, S</creatorcontrib><creatorcontrib>Espejel-Guzman, A</creatorcontrib><creatorcontrib>Lerma, C</creatorcontrib><creatorcontrib>Leon, P</creatorcontrib><creatorcontrib>Guerra, E C</creatorcontrib><creatorcontrib>Espinoza Fernandez, J R</creatorcontrib><creatorcontrib>Martinez-Dominguez, P</creatorcontrib><creatorcontrib>Serrano-Roman, J</creatorcontrib><creatorcontrib>Cabello-Ganem, A</creatorcontrib><creatorcontrib>Aparicio-Ortiz, A D</creatorcontrib><creatorcontrib>Keirns, C</creatorcontrib><creatorcontrib>Lerma, A</creatorcontrib><creatorcontrib>Santa Ana-Bayona, M J</creatorcontrib><title>Heart rate variability-based prediction of early cardiotoxicity in breast-cancer patients treated with anthracyclines and trastuzumab</title><title>European heart journal</title><description>Abstract
Background
Cardiotoxicity is a recognized complication in breast cancer (BC) patients undergoing chemotherapy with anthracyclines with or without trastuzumab. However, the prognostic value of heart rate variability (HRV) indexes for early cardiotoxicity development remains unknown.
Purpose
This study aimed to investigate cardiac autonomic responses to physiological stimuli in BC patients treated with anthracyclines with or without trastuzumab, and to evaluate the predictive value of transthoracic echocardiography (TTE) findings and HRV indexes for early cardiotoxicity.
Methods
A prospective cohort study involving 50 BC patients was conducted at a tertiary hospital with TTE assessments performed before and three months after chemotherapy. HRV indexes were obtained from continuous electrocardiograms in supine position with spontaneous breathing, active standing, and supine position with controlled breathing. The magnitude of change (Δ) between supine-standing and supine-controlled breathing was calculated. Variables were compared using t-test or ANOVA. Cardiotoxicity predictive value was assessed by ROC curve analysis. A p value of < 0.05 was considered significant.
Results
In our cohort, the mean age was 50 ± 8 years, and reported comorbidities included diabetes (n= 9), hypertension (n= 17), and dyslipidemia (n= 11). Twenty-three patients fulfilled echocardiographic and troponin cardiotoxicity criteria or both. TTE revealed reduced left atrial conduit strain in the cardiotoxicity group. Mean heart rate increased during all maneuvers at follow-up, with no differences in HRV indexes between patients with or without cardiotoxicity. However, a lower Δ in supine-controlled breathing of several HRV indexes predicted early cardiotoxicity identified by echocardiography (e.g. SDNN ≤ -8.44 ms: Sensitivity = 75%, Specificity = 69%).
Conclusion
BC patients treated with chemotherapy maintain cardiac autonomic responses to physiological stimuli after 3 months of chemotherapy. However, a lower Δ during active standing and controlled breathing before chemotherapy may predict early cardiotoxicity.Table 1.ROC curve analysisFigure 1.HRV-indexes</description><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNqNkLFOwzAQhi0EEqXwCsgvkNZOYtceUQUUqRJLB7boYp8VV2kS2S4Qdt6bVEXMTKe7-79_-Ai552zBmS6WeAwNQkj7JTaAUspFwbW-IDMu8jzTshSXZMa4FpmU6u2a3MS4Z4wpyeWMfG9OKA2QkL5D8FD71qcxqyGipUNA603yfUd7R6dkO1IDwfo-9Z_eTEHqO1oHhJgyA53BQAdIHrsUaZrOaSr58Kmh0KUmgBlN6zuM02qn_0Qdv44HqG_JlYM24t3vnJPd0-Nuvcm2r88v64dtZpTWmSuLcoWiltzYleNKlqCkFEo4a1kpa4u50ytuuUMuLCqhuc5zZ2wpc1Q5FHMiz7Um9DEGdNUQ_AHCWHFWnVxWfy6rX5fVyeUE8jPYH4f_Mj9OuIHM</recordid><startdate>20241028</startdate><enddate>20241028</enddate><creator>Espinola-Zavaleta, N</creator><creator>Luna-Alcala, S</creator><creator>Espejel-Guzman, A</creator><creator>Lerma, C</creator><creator>Leon, P</creator><creator>Guerra, E C</creator><creator>Espinoza Fernandez, J R</creator><creator>Martinez-Dominguez, P</creator><creator>Serrano-Roman, J</creator><creator>Cabello-Ganem, A</creator><creator>Aparicio-Ortiz, A D</creator><creator>Keirns, C</creator><creator>Lerma, A</creator><creator>Santa Ana-Bayona, M J</creator><general>Oxford University Press</general><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20241028</creationdate><title>Heart rate variability-based prediction of early cardiotoxicity in breast-cancer patients treated with anthracyclines and trastuzumab</title><author>Espinola-Zavaleta, N ; Luna-Alcala, S ; Espejel-Guzman, A ; Lerma, C ; Leon, P ; Guerra, E C ; Espinoza Fernandez, J R ; Martinez-Dominguez, P ; Serrano-Roman, J ; Cabello-Ganem, A ; Aparicio-Ortiz, A D ; Keirns, C ; Lerma, A ; Santa Ana-Bayona, M J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c899-f4347e5b61cd7f1864a866585fdd046bde2f971d1fe15de8591922fcd462e82a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Espinola-Zavaleta, N</creatorcontrib><creatorcontrib>Luna-Alcala, S</creatorcontrib><creatorcontrib>Espejel-Guzman, A</creatorcontrib><creatorcontrib>Lerma, C</creatorcontrib><creatorcontrib>Leon, P</creatorcontrib><creatorcontrib>Guerra, E C</creatorcontrib><creatorcontrib>Espinoza Fernandez, J R</creatorcontrib><creatorcontrib>Martinez-Dominguez, P</creatorcontrib><creatorcontrib>Serrano-Roman, J</creatorcontrib><creatorcontrib>Cabello-Ganem, A</creatorcontrib><creatorcontrib>Aparicio-Ortiz, A D</creatorcontrib><creatorcontrib>Keirns, C</creatorcontrib><creatorcontrib>Lerma, A</creatorcontrib><creatorcontrib>Santa Ana-Bayona, M J</creatorcontrib><collection>CrossRef</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Espinola-Zavaleta, N</au><au>Luna-Alcala, S</au><au>Espejel-Guzman, A</au><au>Lerma, C</au><au>Leon, P</au><au>Guerra, E C</au><au>Espinoza Fernandez, J R</au><au>Martinez-Dominguez, P</au><au>Serrano-Roman, J</au><au>Cabello-Ganem, A</au><au>Aparicio-Ortiz, A D</au><au>Keirns, C</au><au>Lerma, A</au><au>Santa Ana-Bayona, M J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Heart rate variability-based prediction of early cardiotoxicity in breast-cancer patients treated with anthracyclines and trastuzumab</atitle><jtitle>European heart journal</jtitle><date>2024-10-28</date><risdate>2024</risdate><volume>45</volume><issue>Supplement_1</issue><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract>Abstract
Background
Cardiotoxicity is a recognized complication in breast cancer (BC) patients undergoing chemotherapy with anthracyclines with or without trastuzumab. However, the prognostic value of heart rate variability (HRV) indexes for early cardiotoxicity development remains unknown.
Purpose
This study aimed to investigate cardiac autonomic responses to physiological stimuli in BC patients treated with anthracyclines with or without trastuzumab, and to evaluate the predictive value of transthoracic echocardiography (TTE) findings and HRV indexes for early cardiotoxicity.
Methods
A prospective cohort study involving 50 BC patients was conducted at a tertiary hospital with TTE assessments performed before and three months after chemotherapy. HRV indexes were obtained from continuous electrocardiograms in supine position with spontaneous breathing, active standing, and supine position with controlled breathing. The magnitude of change (Δ) between supine-standing and supine-controlled breathing was calculated. Variables were compared using t-test or ANOVA. Cardiotoxicity predictive value was assessed by ROC curve analysis. A p value of < 0.05 was considered significant.
Results
In our cohort, the mean age was 50 ± 8 years, and reported comorbidities included diabetes (n= 9), hypertension (n= 17), and dyslipidemia (n= 11). Twenty-three patients fulfilled echocardiographic and troponin cardiotoxicity criteria or both. TTE revealed reduced left atrial conduit strain in the cardiotoxicity group. Mean heart rate increased during all maneuvers at follow-up, with no differences in HRV indexes between patients with or without cardiotoxicity. However, a lower Δ in supine-controlled breathing of several HRV indexes predicted early cardiotoxicity identified by echocardiography (e.g. SDNN ≤ -8.44 ms: Sensitivity = 75%, Specificity = 69%).
Conclusion
BC patients treated with chemotherapy maintain cardiac autonomic responses to physiological stimuli after 3 months of chemotherapy. However, a lower Δ during active standing and controlled breathing before chemotherapy may predict early cardiotoxicity.Table 1.ROC curve analysisFigure 1.HRV-indexes</abstract><cop>US</cop><pub>Oxford University Press</pub><doi>10.1093/eurheartj/ehae666.3199</doi></addata></record> |
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| source | Oxford University Press Journals All Titles (1996-Current) |
| title | Heart rate variability-based prediction of early cardiotoxicity in breast-cancer patients treated with anthracyclines and trastuzumab |
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