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Original research
Sarcopenia and anthracycline cardiotoxicity in patients with cancer
  1. Onur Bas1,
  2. Ahmet Gurkan Erdemir2,
  3. Mehmet Ruhi Onur2,
  4. Necla Ozer3,
  5. Yusuf Ziya Sener3,
  6. Salih Aksu4,
  7. Ibrahim Barista5,
  8. Gurkan Guner6,
  9. Deniz Can Guven6,
  10. Neyran Kertmen6,
  11. Sercan Aksoy6,
  12. Alev Turker6 and
  13. Omer Dizdar6
  1. 1 Department of Internal Medicine, Hacettepe University, Ankara, Turkey
  2. 2 Department of Radiology, Hacettepe University, Ankara, Turkey
  3. 3 Department of Cardiology, Hacettepe University, Ankara, Turkey
  4. 4 Department of Hematology, Hacettepe University, Ankara, Turkey
  5. 5 Department of Medical Oncology, Hacettepe University, Ankara, Turkey
  6. 6 Department of Medical Oncology, Hacettepe University Cancer Institute, Ankara, Turkey
  1. Correspondence to Dr Onur Bas, Department of Internal Medicine, Hacettepe University, Ankara 06100, Turkey; onurbasdr{at}gmail.com

Abstract

Background Several studies have suggested that sarcopenia is associated with an increased treatment toxicity in patients with cancer. The aim of this study is to evaluate the relationship between sarcopenia and anthracycline-related cardiotoxicity.

Methods Patients who received anthracycline-based chemotherapy between 2014 and 2018 and had baseline abdominal CT and baseline and follow-up echocardiography after anthracycline treatment were included. European Society of Cardiology ejection fraction criteria and American Society of Echocardiography diastolic dysfunction criteria were used for definition of cardiotoxicity. Sarcopenia was defined on the basis of skeletal muscle index (SMI) and psoas muscle index (PMI) calculated on CT images at L3 and L4 vertebra levels.

Results A total of 166 patients (75 men and 91 women) were included. Sarcopenia was determined in 33 patients (19.9%) according to L3-SMI, in 17 patients (10.2%) according to L4-SMI and in 45 patients (27.1%) according to PMI. 27 patients (16.3%) developed cardiotoxicity. PMI and L3-SMI were significantly associated with an increased risk of cardiotoxicity (L3-SMI: HR=3.27, 95% CI 1.32 to 8.11, p=0.01; PMI: HR=3.71, 95% CI 1.58 to 8.73, p=0.003).

Conclusions This is the first study demonstrating a significant association between CT-diagnosed sarcopenia and anthracycline-related cardiotoxicity. Routine CT scans performed for cancer staging may help clinicians identify high-risk patients in whom closer follow-up or cardioprotective measures should be considered.

  • cancer
  • heart failure
  • supportive care

Data availability statement

Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author upon reasonable request.

https://doi.org/10.1136/bmjspcare-2021-003197

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    Data availability statement

    Data are available upon reasonable request. The data that support the findings of this study are available from the corresponding author upon reasonable request.

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    Footnotes

    • Contributors OB: Data curation, formal analysis, investigation, writing—original draft, and writing—review and editing. AGE, MRO: Data curation, formal analysis, investigation. NO, YZS: Data curation, Investigation and writing—review and editing. GG, DCG, NK: Data curation, formal analysis and writing—review and editing. SA: Data curation, formal analysis, investigation, writing—original draft, and writing—review and editing. AT, IB, SA: Investigation and writing–review and editing. OD : Conceptualisation, data curation, formal analysis, investigation, writing—original draft, and writing—review and editing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.