Abstract

Cardiopulmonary exercise tests (CPET) focusing on analyses of heart rate (HR) responses and chronotropic incompetence (CI) could provide early information about treatment’s negative cardiac effects. We examined childhood acute lymphoblastic leukemia (ALL) survivors’ HR response during maximal CPET and identified survivors with CI. A total of 250 childhood ALL survivors underwent a CPET on ergocycle to assess their HR response. We used a multiparametric structure of three methods to assess survivors’ CI, as follows: 1) age-predicted HR_max (APMHR): failure to achieve 85% of the APMHR at the peak of CPET; 2) HR reserve (HRR): failure to achieve 80% of the HRR at the peak of CPET; and 3) metabolic chronotropic relationship (MCR): failure to reach an MCR slope ratio >0.8 at each stage of the CPET. Among 250 childhood ALL survivors, 216 survivors performed a maximum CPET. We observed that 73 males and 74 females did not achieve their predicted HR_max. We found that 6 survivors did not achieve 85% of their APMHR (80.9 ± 3.9%) and had an MCR below 80% (53.9 ± 13.8%). In addition, 16 survivors did not achieve 80% of their HRR (71.0 ± 7.4%) and among them, 15 survivors had an MCR below 80% (61.0 ± 12.1%). Survivors with CI had a significantly lower cardiorespiratory fitness than those without CI. This study shows that survivors are at risk of developing altered HR responses and CI many years after the end of their cancer treatments. These findings highlight the importance of early detection of cardiac damage due to cancer treatments.

摘要

心肺运动测试 (CPET) 侧重于分析心率 (HR) 反应和变时性机能不全 (CI)，可以提供有关治疗对心脏的负面影响的早期信息。我们检查了最大 CPET 期间儿童急性淋巴细胞白血病 (ALL) 幸存者的 HR 反应，并确定了 CI 幸存者。共有 250 名儿童 ALL 幸存者接受了麦角循环 CPET 以评估他们的 HR 反应。我们使用了三种方法的多参数结构来评估幸存者的 CI，如下所示：1) 年龄预测的 HR_最大值(APMHR)：在 CPET 峰值时未能达到 APMHR 的 85%；2）HR储备（HRR）：在CPET高峰期未能达到HRR的80%；和 3) 代谢变时关系 (MCR)：在 CPET 的每个阶段未能达到 MCR 斜率 > 0.8。在 250 名儿童 ALL 幸存者中，216 名幸存者进行了最大的 CPET。我们观察到 73 名男性和 74 名女性没有达到他们预测的_最大心率. 我们发现 6 名幸存者没有达到其 APMHR 的 85% (80.9 ± 3.9%)，并且 MCR 低于 80% (53.9 ± 13.8%)。此外，16 名幸存者未达到其 HRR 的 80% (71.0 ± 7.4%)，其中 15 名幸存者的 MCR 低于 80% (61.0 ± 12.1%)。与没有 CI 的幸存者相比，具有 CI 的幸存者的心肺健康显着降低。这项研究表明，在癌症治疗结束多年后，幸存者有可能发生改变的 HR 反应和 CI。这些发现强调了早期发现癌症治疗引起的心脏损伤的重要性。