Author + information
- Received March 31, 2014
- Revision received July 19, 2014
- Accepted July 22, 2014
- Published online September 30, 2014.
- Larissa Cramer∗,
- Bert Hildebrandt, MD†,
- Thomas Kung∗,
- Kristin Wichmann∗,
- Jochen Springer, PhD‡,§,
- Wolfram Doehner, MD, PhD∗,‖,
- Anja Sandek, MD∗,
- Miroslava Valentova‡,¶,
- Tatjana Stojakovic, MD#,
- Hubert Scharnagl, PhD#,
- Hanno Riess, MD†,
- Stefan D. Anker, MD, PhD∗,‡ and
- Stephan von Haehling, MD, PhD∗,§∗ ()
- ∗Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
- †Department of Hematology and Oncology, Charité Medical School, Campus Virchow-Klinikum, Berlin, Germany
- ‡Department of Innovative Clinical Trials, University Medical Centre Göttingen, Göttingen, Germany
- §Department of Cardiology and Pneumology, University Medical Centre Göttingen, Göttingen, Germany
- ‖Center for Stroke Research CSB, Charité Medical School, Berlin, Germany
- ¶1st Department of Internal Medicine, Faculty Hospital, Bratislava, Slovak Republic
- #Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
- ↵∗Reprint requests and correspondence:
Dr. Stephan von Haehling, Applied Cachexia Research, Department of Cardiology, Charité Medical School–Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
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.
Ms. Cramer was supported by a grant from the Charité Medical School. Part of this project was supported by grant agreement number 241558 under the 7th framework program of the European Commission (SICA-HF). Dr. Anker has received consultation fees from Psioxus, Aveo Oncology, and GTx; and consultation and speaking fees from Helsinn and Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 31, 2014.
- Revision received July 19, 2014.
- Accepted July 22, 2014.
- American College of Cardiology Foundation