Left ventricular strain and strain rate responses to submaximal exercise in prostate cancer patients treated with androgen deprivation therapy

Abstract

Background: Androgen Deprivation Therapy (ADT) is a commonly used treatment for prostate cancer with controversy currently surrounding its association with long-term cardiovascular disease risk. Therefore, the aim of the current investigation was to non-invasively measure left ventricular mechanics at rest and during submaximal exercise in human prostate cancer survivors with and without a history of ADT. Methods: Eighteen prostate cancer survivors, 9 with a history of ADT and 9 matched (1:1) non-ADT controls, completed the protocol. Standard and tissue Doppler echocardiography were used to evaluate left ventricular systolic and diastolic function at rest and during submaximal cycling exercise. Results: At rest, there were no differences between groups. Ejection fraction was not different between groups at rest or during exercise (rest p=0.7; exercise p=0.8). During exercise, systolic left ventricular longitudinal strain and strain rate failed to increase in the ADT group (p=0.4; p=0.07), but significantly increased in the non-ADT group (p=0.03; p=0.02). During exercise, systolic strain was significantly different between groups (p=0.02). Diastolic longitudinal strain increased with exercise in both groups (p=0.003; p=0.003). In the ADT group during exercise, mitral valve deceleration time was not significantly different from rest (p=0.8) and was slower compared to non-ADT (p=0.03). Conclusion: In prostate cancer survivors with a history of ADT, there are significant abnormalities of left ventricular systolic function that become apparent with exercise. These findings may hold significant value beyond the standard resting characterization of ventricular function, in particular as part of a risk-stratification strategy.