Myocardial Function in Premenopausal Women Treated With Ovarian Function Suppression and an Aromatase Inhibitor

Jennifer H Jordan; Ralph B D’Agostino; Katherine Ansley; Emily Douglas; Susan Melin; Steven Sorscher; Sujethra Vasu; Sung Park; Anuj Kotak; Paul A Romitti; Nathanial S O’Connell; William G Hundley; Alexandra Thomas

doi:10.1093/jncics/pkab071

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Myocardial Function in Premenopausal Women Treated With Ovarian Function Suppression and an Aromatase Inhibitor

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Myocardial Function in Premenopausal Women Treated With Ovarian Function Suppression and an Aromatase Inhibitor

Jennifer H Jordan, Ralph B D’Agostino, Katherine Ansley, Emily Douglas, Susan Melin, Steven Sorscher, Sujethra Vasu, Sung Park, Anuj Kotak, Paul A Romitti, …

JNCI cancer spectrum, Vol.5(4), pp.pkab071-pkab071

07/06/2021

DOI: 10.1093/jncics/pkab071

PMCID: PMC8406435

PMID: 34476341

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Abstract

Abstract Background Premenopausal women with high-risk hormone receptor (HR)-positive breast cancer often receive ovarian function suppression (OFS) with aromatase inhibitor therapy; however, abrupt menopause induction, together with further decrements in estrogen exposure through aromatase inhibition, may affect cardiovascular microcirculatory function. We examined adenosine-induced changes in left ventricular (LV) myocardial T1, a potential subclinical marker of LV microcirculatory function in premenopausal women undergoing treatment for breast cancer. Methods Twenty-one premenopausal women (14 with HR-positive breast cancer receiving OFS with an aromatase inhibitor and 7 comparator women with triple-negative breast cancer [TNBC] who had completed primary systemic therapy) underwent serial resting and adenosine cardiovascular magnetic resonance imaging measurements of LV myocardial T1 and LV volumes, mass, and ejection fraction. All statistical tests were 2-sided. Results After a median of 4.0 months (range = 3.1-5.7 months), the stress to resting ratio of LV myocardial T1 declined in women with HR-positive breast cancer (−1.3%, 95% confidence interval [CI] = −3.4% to 0.7%) relative to those with TNBC (3.2%, 95% CI = −1.2% to 7.6%, P = .02). After accounting for age, LV stroke volume, LV ejection fraction, diastolic blood pressure, and breast cancer subtype women with HR-positive breast cancer experienced a blunted T1 response after adenosine relative to women with TNBC (difference = −4.7%, 95% CI = −7.3% to −2.1%, Pdifference = .002). Conclusions Over the brief interval examined, women with HR-positive breast cancer receiving OFS with an aromatase inhibitor experienced reductions in adenosine-associated changes in LV myocardial T1 relative to women who received nonhormonal therapy for TNBC. These findings suggest a possible adverse impact on LV myocardial microcirculatory function in premenopausal women with breast cancer receiving hormone deprivation therapy.

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Title: Subtitle: Myocardial Function in Premenopausal Women Treated With Ovarian Function Suppression and an Aromatase Inhibitor
Creators: Jennifer H Jordan - Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA, Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University Health Sciences, Richmond, VA, USA
Ralph B D’Agostino - Department of Biostatistics and Data Science, Wake Forest University Health Sciences, Winston-Salem, NC, USA, Wake Forest Comprehensive Cancer Center, Wake Forest University School of Medicine, Wake Forest University, Winston-Salem, NC, USA
Katherine Ansley - Wake Forest Comprehensive Cancer Center, Wake Forest University School of Medicine, Wake Forest University, Winston-Salem, NC, USA
Emily Douglas - Wake Forest Comprehensive Cancer Center, Wake Forest University School of Medicine, Wake Forest University, Winston-Salem, NC, USA
Susan Melin - Wake Forest Comprehensive Cancer Center, Wake Forest University School of Medicine, Wake Forest University, Winston-Salem, NC, USA
Steven Sorscher - Wake Forest Comprehensive Cancer Center, Wake Forest University School of Medicine, Wake Forest University, Winston-Salem, NC, USA
Sujethra Vasu - Wake Forest Comprehensive Cancer Center, Wake Forest University School of Medicine, Wake Forest University, Winston-Salem, NC, USA
Sung Park - Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA
Anuj Kotak - Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, USA
Paul A Romitti - Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA, USA
Nathanial S O’Connell - Department of Biostatistics and Data Science, Wake Forest University Health Sciences, Winston-Salem, NC, USA, Wake Forest Comprehensive Cancer Center, Wake Forest University School of Medicine, Wake Forest University, Winston-Salem, NC, USA
William G Hundley - Pauley Heart Center, Department of Internal Medicine, Virginia Commonwealth University Health Sciences, Richmond, VA, USA
Alexandra Thomas - Wake Forest Comprehensive Cancer Center, Wake Forest University School of Medicine, Wake Forest University, Winston-Salem, NC, USA
Resource Type: Journal article
Publication Details: JNCI cancer spectrum, Vol.5(4), pp.pkab071-pkab071
DOI: 10.1093/jncics/pkab071
PMID: 34476341
PMCID: PMC8406435
ISSN: 2515-5091
eISSN: 2515-5091
Language: English
Date published: 07/06/2021
Academic Unit: Epidemiology; Biostatistics; Internal Medicine
Record Identifier: 9984216742302771

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