Key result
Colorectal cancer is linked to ~6 mL/kg/min lower peak VO2 and reduced LVEF versus controls.
Why the study?
Patients with colorectal cancer often present with dyspnea and fatigue similar to chronic heart failure, prompting the hypothesis that similar patterns of cardiovascular perturbations are present in both conditions.
Do patients with colorectal cancer exhibit impaired cardiovascular function and reduced exercise capacity compared with healthy controls and patients with chronic heart failure?
Cohort (n=152)
Do patients with colorectal cancer exhibit impaired cardiovascular function and reduced exercise capacity compared with healthy controls and patients with chronic heart failure?
Patients with colorectal cancer exhibit significant impairments in LVEF, exercise capacity (peak VO2), leg lean mass, and heart rate variability compared with controls, independent of prior chemotherapy exposure.
Answers are grounded in this paper and cite their sources.
May support pre-treatment cardiovascular evaluation in colorectal cancer; leaves open whether predictors improve outcomes or warrant routine screening.
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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Cramer et al. (2014) conducted a cohort in Colorectal cancer and chronic heart failure (n=152). Colorectal cancer vs. Control subjects (n=51) and chronic heart failure patients (n=51) was evaluated on Exercise performance (peak VO2) and left ventricular ejection fraction (LVEF) (p=<0.02). Colorectal cancer was associated with significantly reduced LVEF (59.4% vs 62.5%) and peak VO2 (21.8 vs 28.0 ml/kg/min) compared with controls (both p<0.02), independent of chemotherapy.
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