Reduced LVEF tied to decline in muscle quality among patients undergoing chemotherapy
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NEW ORLEANS — Reduced left ventricular ejection fraction may be tied to adverse changes in muscle quality among patients with breast cancer or lymphoma undergoing cancer treatment with anthracyclines, a speaker reported.
The results of the PREVENT-WF-98213 study were presented at the American College of Cardiology Scientific Session.
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“Cancer survivors who received anthracycline-based chemotherapy (ANTH) are at increased risk of cancer therapy-related cardiovascular dysfunction and reduced LVEF, contributing to a heightened risk of developing HF. Greater ectopic fat, such as intermuscular fat (IMF), is also linked to poor cardiovascular outcomes,” Moriah P. Bellissimo, PhD, RD, postdoctoral fellow at the Pauley Heart Center, division of cardiology at Virginia Commonwealth University School of Medicine, and colleagues wrote in a simultaneous publication in JACC: CardioOncology. “The effects of ANTH treatment on IMF, an indicator of muscle quality, and the relationship of IMF to reduced LVEF are unknown.”
The parent study of this ancillary, nested case-control study included 44 patients with anthracycline-treated breast cancer or lymphoma (mean age, 52 years; 93% women; 87% white; mean BMI, 30.3 kg/m2) assigned to atorvastatin 40 mg per day or placebo.
At baseline, 16 patients had marked declines in LVEF while their 28 counterparts did not.
For the present study, Bellissimo and colleagues evaluated change in muscle quality during 24 months among patients undergoing cancer therapy and whether muscle quality changes differed between patients with reduced LVEF.
At baseline and 24 months, participants underwent cardiac MRI to assess LVEF and abdominal composition.
The researchers calculated ratio of IMF to skeletal muscle, an indicator of muscle quality.
Before receiving chemotherapy, participants had similar skeletal muscle (P = .39), IMF (P = .28) and IMF-to-skeletal muscle ratio (P = .19) compared with controls.
At 24 months, skeletal muscle declined 2% (P = .47), IMF increased 32% (P < .001) and the IMF-to-skeletal muscle ratio increased 38% (P = .005), among all participants, resulting in lower muscle quality, according to the study.
After chemotherapy at 24 months, changes in IMF (3.4 cm2 vs. 1.2 cm2; P = .049) and IMF-to-skeletal muscle ratio (0.14 vs. 0.04; P = .03) were greater among patients with reduced LVEF compared with those who without it.
Researchers observed that patients with reduced LVEF had higher IMF (11.4 cm2 vs. 9 cm2; P = .032) and IMF-to-skeletal muscle ratio (0.42 vs. 0.32; P = .03) at 24 months compared with patients without reduced LVEF.
“This study demonstrates that muscle quality decreases during anthracycline treatment and is more pronounced in individuals with marked declines in LVEF,” the researchers wrote. “Additional work is needed to determine if muscle quality declines precede the onset of HF and test approaches for maintaining muscle quality throughout cancer treatment.”
Reference:
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Bellissimo MP, et al. Abstract 1045-07. Presented at: American College of Cardiology Scientific Session; March 4-6, 2023; New Orleans (hybrid meeting).
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