AUTHOR=Demissei Biniyam G. , Lv WenJian , Wilcox Nicholas S. , Sheline Karyn , Smith Amanda M. , Sturgeon Kathleen M. , McDermott-Roe Chris , Musunuru Kiran , Lefebvre Bénédicte , Domchek Susan M. , Shah Payal , Ky Bonnie 

TITLE=BRCA1/2 Mutations and Cardiovascular Function in Breast Cancer Survivors

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.833171

DOI=10.3389/fcvm.2022.833171

ISSN=2297-055X

ABSTRACT=Objective: Animal models suggest that BRCA1/2 mutations increase doxorubicin-induced cardiotoxicity risk but data in humans are limited. We aimed to determine whether germline BRCA1/2 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) BRCA1/2 mutation carriers treated with doxorubicin; (2) BRCA1/2 mutation non-carriers treated with doxorubicin, and (3) BRCA1/2 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 in vitro study was performed to assess the impact of BRCA1 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 patients receiving doxorubicin regardless of BRCA1/2 mutation status (p=0.03). In doxorubicin-treated BRCA1/2 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 VO2max were observed across the three groups (Poverall=0.07). Doxorubicin caused a dose-dependent reduction in viability of iPSC-CMs in vitro without differences between BRCA1 mutant and wild type controls (p>0.05).
Conclusions: BRCA1/2 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 BRCA1/2 mutations in women with breast cancer.