Background: Myocardial atrophy and left ventricular (LV) mass reductions are associated with fatigue and exercise intolerance. The relationships between the receipt of anthracycline-based chemotherapy (Anth-bC) and changes in LV mass and heart failure (HF) symptomatology are unknown, as is their relationship to LV ejection fraction (LVEF), a widely used measurement performed in surveillance strategies designed to avert symptomatic HF associated with cancer treatment.

Methods and Results: We performed blinded, serial assessments of body weight, LVEF and mass, LV-arterial coupling, aortic stiffness, and Minnesota Living with Heart Failure Questionnaire measures before and 6 months after initiating Anth-bC (n=61) and non–Anth-bC (n=15), and in 24 cancer-free controls using paired t and χ² tests and multivariable linear models. Participants averaged 51±12 years, and 70% were women. Cancer diagnoses included breast cancer (53%), hematologic malignancy (42%), and soft tissue sarcoma (5%). We observed a 5% decline in both LVEF (P<0.0001) and LV mass (P=0.03) in the setting of increased aortic stiffness and disrupted ventricular-arterial coupling in those receiving Anth-bC but not other groups (P=0.11–0.92). A worsening of the Minnesota Living with Heart Failure Questionnaire score in Anth-bC recipients was associated with myocardial mass declines (r=−0.27; P<0.01) but not with LVEF declines (r=0.11; P=0.45). Moreover, this finding was independent of LVEF changes and body weight.

Conclusions: Early after Anth-bC, LV mass reductions associate with worsening HF symptomatology independent of LVEF. These data suggest an alternative mechanism whereby anthracyclines may contribute to HF symptomatology and raise the possibility that surveillance strategies during Anth-bC should also assess LV mass.

背景：心肌萎缩和左心室（LV）质量下降与疲劳和运动不耐症有关。基于蒽环类药物的化疗（Anth-bC）与左室重量和心力衰竭（HF）症状变化之间的关系尚不清楚，它们与左室射血分数（LVEF）的关系也是未知的，左室射血分数是在监测策略中广泛使用的测量方法旨在避免与癌症治疗相关的症状性心力衰竭。

方法和结果：在开始Anth-bC（n = 61）之前和之后6个月，我们对体重，LVEF和质量，LV动脉耦合，主动脉僵硬以及明尼苏达州心衰患者问卷进行了盲目，连续评估。 -Anth-BC（N = 15），并且在使用成对24无癌对照吨和χ ^2个检验和多变量线性模型。参与者平均51±12岁，其中70％是女性。癌症诊断包括乳腺癌（53％），血液系统恶性肿瘤（42％）和软组织肉瘤（5％）。我们观察到LVEF（P <0.0001）和LV质量（P= 0.03）的情况下，接受Anth-bC但未接受其他治疗的人群的主动脉僵硬度增加且心室-动脉耦合受到破坏（P = 0.11-0.92）。在Anth-bC接受者中，明尼苏达州患有心力衰竭调查问卷评分的恶化与心肌质量下降（r = -0.27; P <0.01）有关，而与LVEF下降无关（r = 0.11; P = 0.45）。而且，该发现与LVEF的变化和体重无关。

结论： Anth-bC术后早期，LV质量降低与HF症状恶化（独立于LVEF）有关。这些数据提示了蒽环类药物可能有助于HF症状的另一种机制，并增加了在Anth-bC期间的监测策略也应评估左室重量的可能性。