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Myocardial dysfunction, congestive heart failure and impaired physical performance may be a consequence of chemoradiotherapy (CRT) in patients with esophageal cancer (EC). The aim was to investigate left ventricular (LV) function at rest and at peak exercise by advanced echocardiography (ECHO) before and after completed CRT and additionally examine the potential alterations in peak cardiopulmonary exercise capacity by oxygen consumption assessment.

Forty-seven EC patients were enrolled. All were referred to curative CRT (41.4-50.4 Gy in 23-28 fractions and carboplatin, paclitaxel) followed by surgery (nCRT), n=38 or CRT, n=9. Evaluation included cardiac biomarkers, electrocardiogram, ECHO at rest and during stress, and a cardiopulmonary exercise test before and after CRT. The primary endpoint was changes in LV global longitudinal strain (GLS). Secondary endpoints were LVEF, LV diastolic function, LVEF and GLS at peak exercise and maximal oxygen consumption. 

Median age was 67 years, 94% males. Tumors were 74% GEJ and 74% adenocarcinomas. TNM classification consisted of 89% ≥ T3 and 51 % ≥ N1. The median time from first examination to start CRT was 3 days (IQR 1,5) and to post CRT follow-up was 1 day (IQR 0,6). There was a significant drop in GLS and LVEF at rest 17.6% vs. 16.4% and 56.4% vs. 55.1%, respectively (p=0.004; p=0.030). Cardiac systolic reserve capacity was impaired, and 10 patients had an absolute fall of at least 5% in LVEF and 2.5% in GLS. Signs of LV diastolic dysfunction increased from 13% to 21%, p=ns. Peak VO2max percent of predicted decreased significantly 87.5% vs. 76.8% (p =0.000). Creatinine, leukocytes, and hemoglobin decreased significantly, and cardiac biomarkers did not change during CRT.

In EC patients LV function and physical performance were significantly reduced immediately after CRT. Additionally, the LV systolic reserve capacity was impaired which was related to the demonstrated decline of the maximal physical performance following CRT. The study highlights that the EC treatment is associated with acute cardiac side effects which might be avoided by individualized heart protective cancer treatment.