title: Trastuzumab-induced cardiomyopathy: incidence and associated risk factors in an inner-city population.
abstract: BACKGROUND
  Although it is known that trastuzumab causes cardiotoxicity, its extent and reversibility are still in question. Earlier studies have not evaluated consecutive patients with reproducible nuclear ventriculography.
  
  
  OBJECTIVE
  We sought to evaluate the baseline characteristics which predispose patients to increased risk of trastuzumab cardiotoxicity and to determine the natural history of the cardiotoxicity.
  
  
  RESULTS
  Left ventricular ejection fraction (LVEF) was measured in 76 women aged 36-73 years who had been treated with trastuzumab at the University of Maryland Greenebaum Cancer Center. LVEF was determined at baseline and then 3, 6, 9, and 12 months after treatment initiation. Cardiotoxicity was defined as ≥ 16% decrease in LVEF or ≥ 10% decrease in LVEF to <50%. There were no differences in comorbidities, earlier treatment, or demographics between patients with and without trastuzumab-induced cardiomyopathy except that African Americans were more likely to develop decreased LVEF (P < .05). Twenty-one patients (28%) met criteria for cardiotoxicity. Four of those patients were continued on trastuzumab and 17 patients had therapy withheld at some point. Only 1 patient developed symptomatic heart failure requiring inpatient hospitalization. LVEF improved in most patients regardless of whether or not trastuzumab was continued.
  
  
  CONCLUSIONS
  Decreased LVEF while undergoing trastuzumab therapy occurs frequently and is usually reversible. African Americans had a higher risk of developing decreased LVEF. These findings raise clinically important questions as to whether it is necessary to discontinue trastuzumab for asymptomatic decrease in LVEF and whether African Americans are more predisposed to a decrease in LVEF while receiving trastuzumab. Further studies carefully assessing LVEF should address these hypotheses.
authors.affiliation: University of Maryland School of Medicine, Divisions of Cardiology and Hematology/Oncology, Department of Medicine, Baltimore, MD.
authors.forename: Kaitlin B
authors.initials: KB
authors.lastname: Baron
authors.affiliation: University of Maryland School of Medicine, Divisions of Cardiology and Hematology/Oncology, Department of Medicine, Baltimore, MD.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Brown
authors.affiliation: University of Maryland School of Medicine, Divisions of Cardiology and Hematology/Oncology, Department of Medicine, Baltimore, MD.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Heiss
authors.affiliation: University of Maryland School of Medicine, Divisions of Cardiology and Hematology/Oncology, Department of Medicine, Baltimore, MD.
authors.forename: Joanne
authors.initials: J
authors.lastname: Marshall
authors.affiliation: University of Maryland School of Medicine, Divisions of Cardiology and Hematology/Oncology, Department of Medicine, Baltimore, MD.
authors.forename: Nancy
authors.initials: N
authors.lastname: Tait
authors.affiliation: University of Maryland School of Medicine, Divisions of Cardiology and Hematology/Oncology, Department of Medicine, Baltimore, MD.
authors.forename: Katherine H R
authors.initials: KH
authors.lastname: Tkaczuk
authors.affiliation: University of Maryland School of Medicine, Divisions of Cardiology and Hematology/Oncology, Department of Medicine, Baltimore, MD. Electronic address: sgottlie@medicine.umaryland.edu.
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Gottlieb
mesh_terms: D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage / Q000009:adverse effects*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D001943:Breast Neoplasms / Q000188:drug therapy*; D009202:Cardiomyopathies / Q000139:chemically induced* / Q000453:epidemiology; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D000068878:Trastuzumab; D014505:Urban Population
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D000068878:Trastuzumab
keywords: Trastuzumab; cardiomyopathy; congestive; heart failure