title: Use of myocardial deformation imaging to detect preclinical myocardial dysfunction before conventional measures in patients undergoing breast cancer treatment with trastuzumab.
abstract: BACKGROUND
  Trastuzumab prolongs survival in patients with human epidermal growth factor receptor type 2-positive breast cancer. Sequential left ventricular (LV) ejection fraction (EF) assessment has been mandated to detect myocardial dysfunction because of the risk of heart failure with this treatment. Myocardial deformation imaging is a sensitive means of detecting LV dysfunction, but this technique has not been evaluated in patients treated with trastuzumab. The aim of this study was to investigate whether changes in tissue deformation, assessed by myocardial strain and strain rate (SR), are able to identify LV dysfunction earlier than conventional echocardiographic measures in patients treated with trastuzumab.
  
  
  METHODS
  Sequential echocardiograms (n = 152) were performed in 35 female patients (51 +/- 8 years) undergoing trastuzumab therapy for human epidermal growth factor receptor type 2-positive breast cancer. Left ventricular EF was measured by 2- and 3-dimensional (2D and 3D) echocardiography, and myocardial deformation was assessed using tissue Doppler imaging and 2D-based (speckle-tracking) strain and SR. Change over time was compared every 3 months between baseline and 12 months.
  
  
  RESULTS
  There was no overall change in 3D-EF, 2D-EF, myocardial E-velocity, or strain. However, there were significant reductions seen in tissue Doppler imaging SR (P < .05), 2D-SR (P < .001), and 2D radial SR (P < .001). A drop > or =1 SD in 2D longitudinal SR was seen in 18 (51%) patients; 13 (37%) had a similar drop in radial SR. Of the 18 patients with reduced longitudinal SR, 3 had a concurrent reduction in EF > or =10%, and another 2 showed a reduction over 20 months follow-up.
  
  
  CONCLUSIONS
  Myocardial deformation identifies preclinical myocardial dysfunction earlier than conventional measures in women undergoing treatment with trastuzumab for breast cancer.
authors.affiliation: University of Queensland, Brisbane Q4102, Australia.
authors.forename: James L
authors.initials: JL
authors.lastname: Hare
authors.forename: Joseph K
authors.initials: JK
authors.lastname: Brown
authors.forename: Rodel
authors.initials: R
authors.lastname: Leano
authors.forename: Carly
authors.initials: C
authors.lastname: Jenkins
authors.forename: Natasha
authors.initials: N
authors.lastname: Woodward
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Marwick
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000556:secondary; D015150:Echocardiography, Doppler / Q000379:methods*; D054459:Elasticity Imaging Techniques; D005260:Female; D006333:Heart Failure / Q000139:chemically induced / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D018570:Risk Assessment; D013318:Stroke Volume; D000068878:Trastuzumab; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068878:Trastuzumab