Mutations and Cardiovascular Function in Breast Cancer Survivors.

Objective: Animal models suggest that mutations increase doxorubicin-induced cardiotoxicity risk but data in humans are limited. We aimed to determine whether germline mutations are associated with cardiac dysfunction in breast cancer survivors.

Methods: In a single-center cross-sectional study, stage I-III breast cancer survivors were enrolled according to three groups: (1) mutation carriers treated with doxorubicin; (2) mutation non-carriers treated with doxorubicin; and (3) mutation carriers treated with non-doxorubicin cancer therapy. In age-adjusted analysis, core-lab quantitated measures of echocardiography-derived cardiac function and cardiopulmonary exercise testing (CPET) were compared across the groups. A complementary study was performed to assess the impact of loss of function on human induced pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) survival following doxorubicin exposure.

Results: Sixty-seven women with mean (standard deviation) age of 50 (11) years were included. Age-adjusted left ventricular ejection fraction (LVEF) was lower in participants receiving doxorubicin regardless of mutation status ( = 0.03). In doxorubicin-treated mutation carriers and non-carriers, LVEF was lower by 5.4% (95% CI; -9.3, -1.5) and 4.8% (95% CI; -9.1, -0.5), respectively compared to carriers without doxorubicin exposure. No significant differences in VO were observed across the three groups (p = 0.07). Doxorubicin caused a dose-dependent reduction in viability of iPSC-CMs without differences between mutant and wild type controls ( > 0.05).

Conclusions: mutation status was not associated with differences in measures of cardiovascular function or fitness. Our findings do not support a role for increased cardiotoxicity risk with mutations in women with breast cancer.