Cardiovascular function and predictors of exercise capacity in patients with colorectal cancer

Larissa Cramer, Bert Hildebrandt, Thomas Kung, Kristin Wichmann, Jochen Springer, Wolfram Doehner, Anja Sandek, Miroslava Valentova, Tatjana Stojakovic, Hubert Scharnagl, Hanno Riess, Stefan D. Anker, Stephan Von Haehling

Research output: Contribution to journalArticlepeer-review


Background Patients with colorectal cancer (CRC) often present with dyspnea and fatigue. These are also frequent symptoms in patients with chronic heart failure (CHF).

Objectives We hypothesized that similar patterns of cardiovascular perturbations are present in CRC and CHF.

Methods We prospectively studied 50 patients with CRC, 51 patients with CHF, and 51 control subjects. The CRC group was divided into 2 subgroups: patients who underwent chemotherapy (n = 26) and chemotherapy-naive patients (n = 24). We assessed exercise capacity (spiroergometry), cardiac function (echocardiography), heart rate variability (Holter electrocardiography), body composition (dual-energy x-ray absorptiometry), and blood parameters.

Results Compared with the control arm, the left ventricular ejection fraction (CRC group 59.4%; control group 62.5%) and exercise performance as assessed by peak oxygen consumption (peak VO2) (CRC group 21.8 ml/kg/min; control group 28.0 ml/kg/min) were significantly reduced in CRC patients (both p <0.02). Markers of heart rate variability were markedly impaired in CRC patients compared with control subjects (all p <0.008). Compared with the control group, the CRC group also showed reduced lean mass in the legs and higher levels of the endothelium-derived C-terminal-pro-endothelin-1 (both p <0.02). Major determinants of cardiovascular function were impaired in chemotherapy-treated patients and in the chemotherapy-naive patients, particularly with regard to exercise capacity, left ventricular ejection fraction, lean mass, and heart rate variability (all p <0.05 vs. control subjects).

Conclusions Some aspects of cardiovascular function are impaired in patients with CRC. More importantly, our findings were evident independently of whether patients were undergoing chemotherapy.

Original languageEnglish
Pages (from-to)1310-1319
Number of pages10
JournalJournal of the American College of Cardiology
Issue number13
Publication statusPublished - Sep 30 2014


  • cardiovascular function
  • colorectal cancer
  • exercise capacity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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