title: Time Trends of Left Ventricular Ejection Fraction and Myocardial Deformation Indices in a Cohort of Women with Breast Cancer Treated with Anthracyclines, Taxanes, and Trastuzumab.
abstract: BACKGROUND
  Trastuzumab, a HER2 monoclonal antibody, has transformed the prognosis of patients with the aggressive HER2-positive breast cancer type. Trastuzumab augments the cardiotoxic effects of anthracyclines, but its effect is thought to be at least partially reversible. The objective of this study was to examine the time trends of left ventricular (LV) size and function in a cohort of women treated with anthracyclines and trastuzumab.
  
  
  METHODS
  Twenty-nine patients >18 years of age with first-time breast cancer treated with anthracyclines and trastuzumab were monitored using echocardiography before, at the completion of, and at a median follow-up of 24.7 months (interquartile range, 15.9-34 months) after the end of their cancer treatment. LV volume, LV ejection fraction, and global peak systolic longitudinal strain and strain rate were measured in the apical four- and two-chamber views. Left ventricular ejection fraction was measured using a modified Simpson's biplane method.
  
  
  RESULTS
  LV end-diastolic and end-systolic volumes increased at the end of treatment compared with baseline and did not recover during follow-up. Left ventricular ejection fraction, strain, and strain rate decreased at the end of treatment compared with baseline (from 64 ± 6% to 59 ± 8%, from -20.0 ± 2.5% to -17.6 ± 2.6%, and from -1.26 ± 0.23 to -1.13 ± 0.16 sec(-1), respectively; P < .05 for all parameters) and remained decreased at follow-up.
  
  
  CONCLUSIONS
  LV dilation and subclinical impairment in cardiac function persists >2 years after the end of anthracycline and trastuzumab treatment, without significant recovery after trastuzumab cessation, suggestive of long-term underlying cardiac damage and remodeling.
authors.affiliation: Cardiac Ultrasound Laboratory and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Tan
authors.affiliation: Cardiac Ultrasound Laboratory and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Souhila
authors.initials: S
authors.lastname: Bouras
authors.affiliation: Cardiac Ultrasound Laboratory and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Heloisa
authors.initials: H
authors.lastname: Sawaya
authors.affiliation: Echocardiography Laboratory and Cardiology Division, Sir Mortimer B. Davis-Jewish General Hospital and McGill University, Montreal, Quebec, Canada.
authors.forename: Igal A
authors.initials: IA
authors.lastname: Sebag
authors.affiliation: Department of Oncology, Sir Mortimer B. Davis-Jewish General Hospital and McGill University, Montreal, Quebec, Canada; Department of Medicine, Segal Cancer Center, Montreal, Quebec, Canada.
authors.forename: Victor
authors.initials: V
authors.lastname: Cohen
authors.affiliation: Cardiac Ultrasound Laboratory and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Picard
authors.affiliation: Cardiac Ultrasound Laboratory and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Passeri
authors.affiliation: MGH Center for Breast Cancer, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Irene
authors.initials: I
authors.lastname: Kuter
authors.affiliation: Cardiac Ultrasound Laboratory and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts. Electronic address: marielle@crosbie.com.
authors.forename: Marielle
authors.initials: M
authors.lastname: Scherrer-Crosbie
mesh_terms: D018943:Anthracyclines / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000008:administration & dosage; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000503:physiopathology; D002306:Cardiac Volume / Q000187:drug effects*; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D013318:Stroke Volume / Q000187:drug effects*; D043823:Taxoids / Q000008:administration & dosage*; D013997:Time Factors; D000068878:Trastuzumab / Q000008:administration & dosage*; D016277:Ventricular Function, Left / Q000187:drug effects*
chemical_list: D018943:Anthracyclines; D000970:Antineoplastic Agents; D043823:Taxoids; D000068878:Trastuzumab
keywords: Breast cancer; Cardiotoxicity; Echocardiography; LVEF; Strain; Strain rate