Document Detail


Circulating neuregulin during the transition from stage A to stage B/C heart failure in a breast cancer cohort.
MedLine Citation:
PMID:  23273589     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Breast cancer (BC) treatments can cause heart failure (HF) in a subset of patients. ACC/AHA guidelines classify patients receiving cardiotoxic medications as stage A, a high-risk population for the development of HF. Circulating neuregulin (NRG) correlates with outcomes in stage C and D HF. We examined the levels of NRG in a BC cohort receiving cardiotoxic chemotherapy and its relationship with adverse cardiac effects during the transition from stage A to stage B or C HF.
METHODS AND RESULTS: In an ongoing prospective study, a planned interim analysis of 78 BC women receiving either anthracycline (AC) or trastuzumab (Tsz) was performed. Biometric data, cardiac risk factors, and NRG levels, were collected before chemotherapy and after completion of AC therapy and/or 3 months into Tsz therapy. Cardiac function was measured by left ventricular ejection fraction (LVEF) by echocardiography at the above time points and longitudinally as standard of care. The interim cohort was predominately white with stage II BC and a median age of 50 years. A reduction of >10 absolute percentage points in LVEF was observed in 21.4% of the cohort, representing a transition from stage A to stage B or C HF. A statistically significant drop in plasma NRG was observed in women treated with AC and/or Tsz (P < .001). Additionally, baseline NRG correlated with the maximal change in LVEF.
CONCLUSIONS: More than 20% of women experienced cardiac dysfunction, detected by decline in LVEF, and were reclassified as stage B or C HF. Plasma NRG levels were reduced after exposure to cardiotoxic chemotherapy, suggesting a loss in a cardioprotective growth factor. Higher baseline NRG levels were observed in those with the greatest decline in LVEF, supporting the continued investigation of NRG as a potential prognostic marker in early-stage HF.
Authors:
Carrie A Geisberg; Wissam M Abdallah; Monica da Silva; Cheri Silverstein; Holly M Smith; Vandana Abramson; Ingrid Mayer; Julie Means-Powell; Darla Freehardt; Brenda White; Daniel Lenihan; Douglas B Sawyer
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of cardiac failure     Volume:  19     ISSN:  1532-8414     ISO Abbreviation:  J. Card. Fail.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2012-12-31     Completed Date:  2013-05-30     Revised Date:  2014-03-19    
Medline Journal Info:
Nlm Unique ID:  9442138     Medline TA:  J Card Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  10-5     Citation Subset:  IM    
Copyright Information:
Published by Elsevier Inc.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anthracyclines / adverse effects,  therapeutic use
Antibodies, Monoclonal, Humanized / adverse effects,  therapeutic use
Antineoplastic Agents / administration & dosage,  adverse effects*
Biological Markers / blood
Breast Neoplasms / drug therapy*,  mortality,  pathology
Cohort Studies
Disease-Free Survival
Dose-Response Relationship, Drug
Drug Administration Schedule
Female
Heart Failure / blood,  chemically induced*,  mortality,  pathology*
Humans
Middle Aged
Neoplasm Invasiveness / pathology
Neoplasm Staging
Neuregulins / blood*,  metabolism
Predictive Value of Tests
Prognosis
Prospective Studies
Risk Assessment
Severity of Illness Index
Statistics, Nonparametric
Stroke Volume / drug effects
Survival Rate
Grant Support
ID/Acronym/Agency:
1-UL1-RR024975/RR/NCRR NIH HHS; HL068144/HL/NHLBI NIH HHS; K23 CA127469/CA/NCI NIH HHS; KL2 RR024977/RR/NCRR NIH HHS; KL2 TR000446/TR/NCATS NIH HHS; T32 HL007411/HL/NHLBI NIH HHS; TL1 RR024978/RR/NCRR NIH HHS; TL1 TR000447/TR/NCATS NIH HHS; UL1 RR024975/RR/NCRR NIH HHS; UL1 TR000445/TR/NCATS NIH HHS
Chemical
Reg. No./Substance:
0/Anthracyclines; 0/Antibodies, Monoclonal, Humanized; 0/Antineoplastic Agents; 0/Biological Markers; 0/Neuregulins; P188ANX8CK/trastuzumab
Comments/Corrections

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