scholarly journals Increased Risk of Congestive Heart Failure Following Carbon Monoxide Poisoning

2021 ◽  
Author(s):  
Chien-Cheng Huang ◽  
Tzu-Hao Chen ◽  
Chung-Han Ho ◽  
Yi-Chen Chen ◽  
Chien-Chin Hsu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Carbon Monoxide ◽  
Cardiac Function ◽  
Carbon Monoxide Poisoning ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Left Ventricular Ejection ◽  
Increased Risk

Background: Carbon monoxide poisoning (COP) is an important public health issue around the world. It may increase the risk of myocardial injury, but the association between COP and congestive heart failure (CHF) remains unclear. We conducted a study incorporating data from epidemiological and animal studies to clarify this issue. Methods: Using the National Health Insurance Database of Taiwan, we identified patients with COP diagnosed between 1999 and 2012 and compared them with patients without COP (non-COP cohort) matched by age and the index date at a 1:3 ratio. The comparison for the risk of CHF between the COP and non-COP cohorts was made using Cox proportional hazards regression. We also established a rat model to evaluate cardiac function using echocardiography and studied the pathological changes following COP. Results: The 20 942 patients in the COP cohort had a higher risk for CHF than the 62 826 members in the non-COP cohort after adjusting for sex and underlying comorbidities (adjusted hazard ratio, 2.01 [95% CI, 1.74–2.32]). The increased risk of CHF persisted even after 2 years of follow-up (adjusted hazard ratio, 1.85 [95% CI, 1.55–2.21]). In the animal model, COP led to a decreased left ventricular ejection fraction on echocardiography and damage to cardiac cells with remarkable fibrotic changes. Conclusions: Our epidemiological data showed an increased risk of CHF was associated with COP, which was supported by the animal study. We suggest close follow-up of cardiac function for patients with COP to facilitate early intervention and further studies to identify other long-term effects that have not been reported in the literature.

scholarly journals Vital exhaustion and cardiovascular prognosis in myocardial infarction and heart failure: predictive power of different trajectories

2010 ◽  
Vol 41 (4) ◽  
pp. 731-738 ◽  
Author(s):  
O. R. F. Smith ◽  
N. Kupper ◽  
J. Denollet ◽  
P. de Jonge
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Hospital Readmission ◽  
Cardiovascular Events ◽  
Cardiac Patients ◽  
Left Ventricular Ejection ◽  
Vital Exhaustion ◽  
Cardiovascular Prognosis ◽  
Increased Risk

BackgroundWe examined the different trajectories of vital exhaustion (VE) over a 12-month period and their impact on prognosis in a sample of myocardial infarction (MI) and chronic heart failure (CHF) patients.MethodConsecutive MI (n=407) and CHF patients (n=297) were assessed at baseline, and at 3- and 12-month follow-up for symptoms of VE. Latent growth mixture modelling was used to examine the course of VE over time. The combined clinical endpoint was defined as cardiac hospital readmission or death.ResultsFour distinct trajectories for VE were found: low VE, decreasing VE, increasing VE, and severe VE. Sex, marital status, left ventricular ejection fraction, psychotropic medication, sample group (CHF v. MI) and depressive symptoms were associated with VE, varying according to classes. The mean follow-up period was 25.3 months in which 34.7% of the patients experienced an event. Multivariate Cox regression showed that, compared with patients in the low VE class, patients in the increasing VE class [hazard ratio (HR)=1.16, 95% confidence interval (CI) 1.58–3.61, p=0.01], and the severe VE class (HR=1.69, 95% CI 1.31–2.64, p=0.02) had an increased risk for adverse cardiovascular events (i.e. cardiovascular hospital readmission or cardiovascular death). Decreasing VE was not related to adverse cardiovascular events (HR=0.97, 95% CI 0.66–1.69, p=0.81).ConclusionsVE trajectories varied across cardiac patients, and had a differential effect on cardiovascular outcome. Increasing VE and severe VE classes were predictors of poor cardiovascular prognosis. These results suggest that identification of cardiac patients with an increased risk of adverse health outcomes should be based on multiple assessments of VE.

scholarly journals Cyproterone Acetate and risk of Meningioma

2021 ◽  
Author(s):  
Anders P. Mikkelsen ◽  
Iben K. Greiber ◽  
Nikolai M. Scheller ◽  
Malene Hilden ◽  
Øjvind Lidegaard
Keyword(s):  
Cumulative Dose ◽  
Cyproterone Acetate ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Response Relationship ◽  
Dose Response Relationship ◽  
National Healthcare ◽  
Background Population ◽  
Increased Risk

AbstractCyproterone acetate (CPA) is a synthetic steroid hormone. We assessed the association between the use of CPA and the risk of developing meningioma.In a historical prospective cohort study, using Danish national healthcare registers we included a cohort of 5,730,654 individuals, among whom 1,982 were exposed to CPA. During follow-up, we identified 8,957 cases of meningioma, of which 16 were exposed to CPA. From 2013 to 2019 the number of new users increased from 18.1 to 62.3 new users per million, while the proportion of new users who were transgender increased from 18.4 to 68.3%. Analyses showed a significantly increased risk of meningioma according to cumulative dose of CPA; 0.1-10 grams of CPA, incidence rate 78.8 (95% CI 15.7-141.9) per 100.000 person years and adjusted hazard ratio 7.0 (3.1-15.6); >10 grams of CPA, incidence 187.5 (71.3-303.7) and adjusted hazard ratio 19.2 (10.3-35.8), as compared to the background population.In conclusion, the cumulative dose of CPA was associated with an increased incidence and hazard ratio of meningioma, showing a dose-response relationship. The number of new CPA users increased more than 3-fold from 2013 to 2019, primarily driven by new transgender users.

scholarly journals Elevated Lp(a) (Lipoprotein[a]) Levels Increase Risk of 30-Day Major Adverse Cardiovascular Events in Patients Following Carotid Endarterectomy

Stroke ◽  
2020 ◽  
Vol 51 (10) ◽  
pp. 2972-2982 ◽  
Author(s):  
Farahnaz Waissi ◽  
Mirthe Dekker ◽  
Nathalie Timmerman ◽  
Renate M. Hoogeveen ◽  
Joelle van Bennekom ◽  
...  
Keyword(s):  
Risk Factor ◽  
Carotid Endarterectomy ◽  
Cardiovascular Events ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Major Adverse Cardiovascular Events ◽  
Lipoprotein A ◽  
Kaplan Meier ◽  
Increased Risk

Background and Purpose: General population studies have shown that elevated Lp(a) (lipoprotein[a]) levels are an emerging risk factor for cardiovascular disease and subsequent cardiovascular events. The role of Lp(a) for the risk of secondary MACE in patients undergoing carotid endarterectomy (CEA) is unknown. Our objective is to assess the association of elevated Lp(a) levels with the risk of secondary MACE in patients undergoing CEA. Methods: Lp(a) concentrations were determined in preoperative blood samples of 944 consecutive patients with CEA included in the Athero-Express Biobank Study. During 3-year follow-up, major adverse cardiovascular events (MACE), consisting of myocardial infarction, stroke, and cardiovascular death, were documented. Results: After 3 years follow-up, Kaplan-Meier cumulative event rates for MACE were 15.4% in patients with high Lp(a) levels (>137 nmol/L; >80th cohort percentile) and 10.2% in patients with low Lp(a) levels (≤137 nmol/L; ≤80th cohort percentile; log-rank test: P =0.047). Cox regression analyses adjusted for conventional cardiovascular risk factors revealed a significant association between high Lp(a) levels and 3-year MACE with an adjusted hazard ratio of 1.69 (95% CI, 1.07–2.66). One-third of MACE occurred within 30 days after CEA, with an adjusted hazard ratio for the 30-day risk of MACE of 2.05 (95% CI, 1.01–4.17). Kaplan-Meier curves from time point 30 days to 3 years onward revealed no significant association between high Lp(a) levels and MACE. Lp(a) levels were not associated with histological carotid plaque characteristics. Conclusions: High Lp(a) levels (>137 nmol/L; >80th cohort percentile) are associated with an increased risk of 30-day MACE after CEA. This identifies elevated Lp(a) levels as a new potential risk factor for secondary cardiovascular events in patients after carotid surgery. Future studies are required to investigate whether Lp(a) levels might be useful in guiding treatment algorithms for carotid intervention.

scholarly journals Risk of ischemic stroke in patients with acute myocardial infarction and new atrial fibrillation: a nationwide analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Fauchier ◽  
A Bisson ◽  
A Bodin ◽  
J Herbert ◽  
T Genet ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Ischemic Stroke ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Risk Of Death ◽  
Increased Risk ◽  
History Of

Abstract Background In patients with acute myocardial infarction (AMI), history of atrial fibrillation (AF) and new onset AF during the early phase may be associated with a worse prognosis. Whether both conditions are associated with a similar risk of stroke and should be similarly managed is a matter of debate. Methods Based on the administrative hospital-discharge database, we collected information for all patients treated with AMI between 2010 and 2019 in France. The adverse outcomes were investigated during follow-up. Results Among 797,212 patients with STEMI or NSTEMI, 146,922 (18.4%) had history of AF, and 11,824 (1.5%) had new AF diagnosed between day 1 and day 30 after AMI. Patients with new AF were older and had more comorbidities than those with no AF but were younger and had less comorbidities than those with history of AF. Both groups with history of AF or new AF had less frequent STEMI and anterior MI, less frequent use of percutaneous coronary intervention but more frequent HF at the acute phase than patients with no AF. During follow-up (mean [SD] 1.8 [2.4] years, median [interquartile range] 0.7 [0.1–3.1] years), 163,845 deaths and 20,168 ischemic strokes were recorded. Using Cox multivariable analysis, compared to patients with no AF, history of AF was associated with a higher risk of death during follow-up (adjusted hazard ratio HR 1.06 95% CI 1.05–1.08) while this was not the case for patients with new AF (adjusted HR 0.98 95% CI 0.95–1.02). By contrast, both history of AF and new AF were associated with a higher risk of ischemic stroke during follow-up compared to patients with no AF: adjusted hazard ratio HR 1.29 95% CI 1.25–1.34 for history of AF, adjusted HR 1.72 95% CI 1.59–1.85 for new AF. New AF was associated with a higher risk of ischemic stroke than history of AF (adjusted HR 1.38 95% CI 1.27–1.49). Conclusion In a large and systematic nationwide analysis, AF first recorded in the first 30 days after AMI was associated with an increased risk of ischemic stroke. Specific management should be considered in order to improve outcomes in these patients after AMI. Funding Acknowledgement Type of funding source: None

scholarly journals Exercise Ventricular Rates, Cardiopulmonary Exercise Performance, and Mortality in Patients With Heart Failure With Atrial Fibrillation

2021 ◽  
Vol 14 (2) ◽  
Author(s):  
Mohamed B. Elshazly ◽  
Bruce L. Wilkoff ◽  
Khaldoun Tarakji ◽  
Yuping Wu ◽  
Eoin Donnellan ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Exercise Capacity ◽  
Exercise Performance ◽  
Stress Testing ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Left Ventricular Ejection ◽  
Peak Exercise ◽  
All Cause Mortality

Background: In heart failure (HF) with sinus rhythm, resting and exercise heart rates correlate with exercise capacity and mortality. However, in HF with atrial fibrillation (AF), this correlation is unknown. Our aim is to investigate the association of resting and exercise ventricular rates (VRs) with exercise capacity and mortality in HF with AF. Methods: We identified 903 patients with HF and AF referred for cardiopulmonary stress testing. AF was defined as history of AF and AF during cardiopulmonary stress testing. We constructed multivariable models to evaluate the association of resting VR, peak exercise VR, VR reserve (peak VR−resting VR), and chronotropic index with (1) peak oxygen consumption (PVO 2 ) ≤18 mL/kg per minute, (2) continuous PVO 2 , and (3) 10-year all-cause mortality. Results: Median (25th–75th percentile) age was 60 (52–67) years, left ventricular ejection fraction was 25 (15–50)%, and 76.1% were males. Patients with lower (quartile 1) compared with higher (quartile 4) peak VR, VR reserve, and chronotropic index were more likely to have PVO 2 ≤18 mL/kg per min (adjusted odds ratio [95% CI]: 14.92 [8.07–27.58], 24.60 [12.36–48.98], and 22.31 [11.24–44.27], respectively), and higher all-cause mortality (adjusted hazard ratio [95% CI]: 2.56 [1.62–4.04], 2.29 [1.47–3.59], and 2.30 [1.51–3.49], respectively). For every 10 beats per minute increase in VR reserve, PVO 2 increased by 1.05 mL/kg per minute (B-coefficient [95% CI]: 1.05 [0.94–1.15]) and mortality decreased by 12% (adjusted hazard ratio [95% CI]: 0.88 [0.83–0.94]). Resting VR was associated with PVO 2 (B-coefficient [95% CI]: −0.46 [−0.70 to −0.23]) but not mortality (adjusted hazard ratio [95% CI]: 0.97 [0.88–1.06]). Conclusions: In patients with HF and AF, higher resting VR and lower peak exercise VR, VR reserve, and chronotropic index were all associated with worse peak exercise capacity, but only lower exercise VR parameters were associated with higher mortality. Dedicated studies are needed to gauge whether modulating exercise VR enhances exercise performance and outcomes.

Abstract MP091: Hypertension is Associated With Increased Risk of Adverse Clinical Outcomes in Women With Peripartum Cardiomyopathy

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Tasnim F Imran ◽  
Donya Mohebali ◽  
Diana Lopez ◽  
Natalie Bello ◽  
Sandy Truong ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cardiac Transplantation ◽  
Left Ventricular ◽  
Peripartum Cardiomyopathy ◽  
Left Ventricular Ejection ◽  
Extra Corporeal Membrane Oxygenation ◽  
Membrane Oxygenation ◽  
Increased Risk

Background: Peripartum cardiomyopathy (PPCM) is a rare condition that carries a high morbidity and mortality among young women. Studies examining the association of modifiable risk factors such as hypertension with outcomes in this population are sparse. Methods: We conducted a multi-center retrospective study across three major centers (BWH, BIDMC, MGH) to identify subjects with PPCM using the following criteria: ejection fraction < 40%, development of heart failure within the last month of pregnancy or within 5 months of delivery and no other identifiable cause of heart failure with reduced ejection fraction. We defined adverse clinical outcome as a composite of heart failure hospitalizations, need for extra-corporeal membrane oxygenation, ejection fraction <35%, cardiac transplantation or death during the follow-up period. Results: In all, 237 women met criteria for PPCM across the three centers between April 1995 and November 2015. Participants had a median age of 33.1 years (IQR: 28.6-38.0), gravida 2.0, para 2.0, mean left ventricular ejection fraction at diagnosis of 30%; 25% had chronic hypertension and 14% had preeclampsia. After a median follow-up of 3.2 years (IQR: 1.0-7.8), 59 events occurred. In a logistic regression model adjusting for age, number of prior pregnancies and number of deliveries, women with preeclampsia had an OR of 1.34 (95% CI: 1.05-1.72), p=0.02 as compared to those without preeclampsia. A similar association was observed for hypertension (Table). In sensitivity analysis, the association between preeclampsia and adverse outcomes persisted for blacks and other races, but not for whites. Conclusion: Our study suggests that hypertension or preeclampsia at diagnosis is associated with increased risk of heart failure hospitalizations, need for extra-corporeal membrane oxygenation, poor left ventricular function recovery, cardiac transplantation and death on follow-up in women with PPCM. Clinicians should consider aggressive treatment of hypertension in women of childbearing age.

P3554CMR Fast-SENC intramyocardial LV & RV segmental strain helps manage cardioprotective therapy in patients exhibiting cardiotoxicity during cancer treatment

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Steen ◽  
M Montenbruck ◽  
P Wuelfing ◽  
S Esch ◽  
A K Schwarz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Heart Failure ◽  
Cardiac Function ◽  
Cancer Treatment ◽  
Cancer Patients ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
The Impact

Abstract Background Cardiotoxicity during cancer treatment has become an acknowledged problem of chemotherapy medications and radiation therapy. Limitations of biomarkers and imaging tests such as echocardiography left ventricular ejection fraction (LVEF) hinder early detection of cardiotoxicity and proactive cardioprotective therapy. Once the heart is unable to compensate for subclinical dysfunction, systemic damage and remodeling occurs increasing the potential for heart failure. Fast-SENC segmental intramyocardial strain (fSENC) is a unique cardiac magnetic resonance imaging (CMR) test that regionally detects subclinical intramyocardial dysfunction in 1 heartbeat. This study evaluates the ability of fSENC to detect subclinical cardiotoxicity and manage cardioprotective therapy in cancer patients. Methods This single center, prospective Prefect Study was used to evaluate cardiotoxicity and the impact of cardioprotective therapy in Breast Cancer and Lymphoma patients (NCT03543228). fSENC was acquired with a 1.5T MRI and processed with the MyoStrain software to quantify intramyocardial strain. Segmental strain was measured in three short axis scans (basal, midventricular & apical) with 16LV/6RV longitudinal segments & three long axis scans (2-, 3-, 4-chamber) with 21LV/5RV circumferential segments. fSENC CMR was performed before chemotherapy, during and after anthracycline/taxan therapy, at 1 year follow-up, and as needed in between designated follow-up periods. Cardioprotective therapy was offered to patients meeting the definition of cardiotoxicity by the ESC Guidelines on Cardiotoxicity and/or ESMO Clinical Practice Guidelines or those observing a substantial decline in cardiac function. Comparisons were made with paired t-Test with a 95% confidence interval. Results Two hundred eight (208) CMRs were performed in fifty-two (52) patients (44 female). Patients had an average (± stdev) age of 53 (15) yrs, BMI of 26 (5) kg/m2; 77% had breast cancer, 23% had Lymphoma. fSENC CMRs required 11 (2) min total exam time. Figure 1 shows bar graphs of the % of normal LV myocardium (e.g. % LV MyoStrain Segments <−17%) at baseline and sequential follow-ups for patients without cardiotoxicity and with cardiotoxicity requiring cardioprotective therapy. Patients observing cardiotoxicity had a statistically significant decline in cardiac function measured by segmental fSENC (p=0.0002) which resolved after cardioprotective therapy. Figure 1 Conclusion Segmental fSENC intramyocardial strain detects subclinical cardiotoxicity during chemotherapy and impact of cardioprotective therapy. The ability to serve as a surrogate safety endpoint for chemotherapy or other pharmacological agents, and aid management of cardiotoxicity by serving as a surrogate efficacy endpoint for cardioprotection agents, dosage, and patient compliance may help physicians detect subclinical cardiac dysfunction, and proactively manage cancer patients to avoid early or late heart failure.

The Timed Up and Go test and the ageing heart: Findings from a national health screening of 1,084,875 community-dwelling older adults

2019 ◽  
pp. 204748731988211 ◽  
Author(s):  
Sohyun Chun ◽  
Dong Wook Shin ◽  
Kyungdo Han ◽  
Jin Hyung Jung ◽  
Bongseong Kim ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Older Adults ◽  
Congestive Heart Failure ◽  
Confidence Interval ◽  
Hazard Ratio ◽  
Adjusted Hazard Ratio ◽  
Timed Up And Go ◽  
Group 3

Aim This study aimed to evaluate the relationship between Timed Up and Go test performance and the incidence of older adult heart diseases and mortality. Methods This was a retrospective cohort study of 1,084,875 older adults who participated in a national health screening program between 2009–2014 (all aged 66 years old). Participants free of myocardial infarction, congestive heart failure, and atrial fibrillation at baseline were included and were divided into Group 1 (<10 s), Group 2 (10−20 s) and Group 3 (≥20 s) using the Timed Up and Go test scores. The endpoints were incident myocardial infarction, congestive heart failure, atrial fibrillation, and all-cause mortality. Results During mean follow-up of 3.6 years (maximum 8.0 years), 8885 myocardial infarctions, 10,617 congestive heart failures, 15,322 atrial fibrillations, and 22,189 deaths occurred. Compared with participants in Group 1, Group 2 and Group 3 participants had higher incidences of myocardial infarction (Group 3: adjusted hazard ratio = 1.40, 95% confidence interval = 1.11–1.77), congestive heart failure (Group 3: adjusted hazard ratio = 1.59, 95% confidence interval = 1.31–1.94) and total mortality (Group 3: adjusted hazard ratio=1.93, 95% confidence interval = 1.69–2.20). The additional risks remained after adjusting for multiple conventional risk factors. For atrial fibrillation, a linear trend of increased risk was observed with slower Timed Up and Go test speed, but was statistically marginal (Group 3: adjusted hazard ratio=1.17, 95% confidence interval=0.96–1.44). Conclusion Slower Timed Up and Go test speed is associated with increased risk of developing myocardial infarction, congestive heart failure, and mortality in older adults.

scholarly journals 432 Traditional markers of myocardial dysfunction fail to detect marked reductions in physical capacity amoung chemotherapy patients

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
E Howden ◽  
S Foulkes ◽  
L Wright ◽  
K Janssens ◽  
H Dillon ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiovascular Function ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Left Ventricular Ejection ◽  
Lv Function ◽  
Cell Transplant ◽  
Ventricular Ejection Fraction ◽  
Increased Risk

Abstract Left ventricular ejection fraction (LVEF) is the current standard of care for evaluating chemotherapy-associated cardiotoxicity but changes in LVEF are poorly associated with outcomes and long-term heart failure risk. We sought to compare a more global measure of integrative cardiovascular function (VO2peak) that is strongly associated heart failure and early mortality risk with LVEF, global longitudinal strain (GLS) and cardiac biomarkers. Methods 95 patients who were due to commence anti-cancer treatment (n = 58 anthracycline chemotherapy for breast cancer; n = 25 Bruton’s tyrosine kinase inhibitor and n = 12 allogeneic stem cell transplant for haematological cancers) completed a pre-treatment and follow-up assessment within 6 months of initiating treatment. Changes in echocardiographic measures of LV function (LVEF, GLS), cardiac biomarkers (troponin and BNP) and cardiopulmonary exercise test (CPET, VO2peak) were measured. Results Of 95 participants who underwent baseline testing, follow-up CPET and echocardiography data was available in 89 participants. LV function was normal prior to treatment (LVEF 61.5 ± 5.9%; GLS -19.4 ± 2.3) but VO2peak (23.4 ± 6.5ml/kg/min) was only 83 ± 21% (range 47-146%) of age-predicted. After treatment, we observed marked reductions in fitness (Δ-2.1 ± 3.7 ml/kg/min or -9 ± 15%, P &lt; 0.001) which was associated with small non-clinically significant changes in LV function (LVEF Δ-2.4 ± 6.4% P = 0.001; GLS Δ-0.5 ± 1.9 P = 0.018). Troponin was increased significantly (4.0 ± 5.5 to 23.5 ± 22.5ng/ml, P &lt; 0.001), with no change in BNP (37.5 ± 31.4 to 32.7 ± 22.0pg/ml, P = 0.87). Current diagnostic criteria for cardiac toxicity were not met in any patient despite some patients developing disabling reductions in functional capacity (VO2peak &lt; 16ml/min/kg). Conclusion Despite normal resting LV function prior to commencing treatment VO2peak was below age predicted. Treatment further impaired exercise cardiovascular function with minimal impact on resting measures of LV function. The assessment of cardiovascular function using CPET prior to, and following chemotherapy may be a more sensitive means of identifying patients at increased risk of future heart failure.

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