title: Subclinical Myocardial Impairment Occurred in Septal and Anterior LV Wall Segments After Anthracycline-Embedded Chemotherapy and did not Worsen During Adjuvant Trastuzumab Treatment in Breast Cancer Patients.
abstract: In a previous study of breast cancer patients, we found changes in cardiac function and size during the early stages of adjuvant trastuzumab (Herceptin(®)) therapy. Here we present a subgroup analysis of this patient cohort. This subgroup received a anthracycline-embedded chemotherapy followed by at least 3 months up to 6 months of adjuvant Herceptin(®) therapy. Twenty-seven female breast cancer patients with Her-2/-neu overexpression were studied using conventional echocardiography and 2D speckle tracking. These methods were done before anthracycline-embedded chemotherapy, before adjuvant trastuzumab therapy, and both 3 and 6 months after the start of the therapy (T3, T6). The LV-EF (Simpson biplane) decreased significantly from before the chemotherapy to after the chemotherapy and further decreased after 3 months of trastuzumab therapy (66.2 ± 1.5 vs. 58.7 ± 1.2 vs. 55.6 ± 1.3 vs. 55.9 ± 1.5 %; p < 0.05). The stroke volume index remained constant after chemotherapy (22.0 ± 0.8 vs. 22.6 ± 1.3 ml/m(2); p = 0.9), but increased significantly during trastuzumab therapy (26.7 ± 1.1 and 27.3 ± 1.0 ml/m(2); p < 0.01). Global longitudinal strain exclusively decreased during chemotherapy (-21.0 ± 0.5 vs. -18.9 ± 0.5 %, p < 0.001). Regional longitudinal strain decreased significantly after chemotherapy in septal, anteroseptal, anterolateral, and apex segments. Mitral valve regurgitation increased during the whole treatment, but especially during trastuzumab. Right ventricular function decreased exclusively during chemotherapy. Anthracycline-embedded chemotherapy in patients with breast cancer led to a decrease in LV function, especially of the septal and anterior segments, and did not worsen during adjuvant trastuzumab treatment.
authors.affiliation: Asklepios-Harz-Klinik Goslar, Medizinische Klinik I, Kardiologie, Angiologie, Diabetologie und Internistische Intensivmedizin, Koesliner Str. 12, 38640, Goslar, Germany. StefanAndreas.Lange@googlemail.com.
authors.forename: Stefan Andreas
authors.identifier: http://orcid.org/0000-0001-9468-6231
authors.initials: SA
authors.lastname: Lange
authors.affiliation: Medizinische Klinik I, Kardiologie und Angiologie, Klinikum Worms, Akademisches Lehrkrankenhaus der Johannes-Gutenberg-Universitaet, Gabriel-von-Seidl-Str. 81, Mainz, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Jung
authors.affiliation: Zentrale Krankenhausapotheke, Harzklinikum D. C. Erxleben, Akademisches Lehrkrankenhaus der Otto-von-Guericke Universitaet Magdeburg, Ilsenburger Str. 15, Wernigerode, Germany.
authors.forename: Almut
authors.initials: A
authors.lastname: Jaeck
authors.affiliation: Frauenklinik, Brustzentrum-Perinatalzentrum, Klinikum Worms, Akademisches Lehrkrankenhaus der Johannes-Gutenberg-Universitaet, Gabriel-von-Seidl-Str. 81, Mainz, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hitschold
authors.affiliation: Medizinische Klinik/Kardiologie, Herzzentrum Dresden, Universitaetsklinik, Technische Universitaet Dresden, Fetscherstr. 76, Dresden, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Ebner
mesh_terms: D000328:Adult; D000368:Aged; D018943:Anthracyclines / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000175:diagnosis / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum / Q000187:drug effects* / Q000502:physiology; D006352:Heart Ventricles / Q000187:drug effects; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D000068878:Trastuzumab / Q000008:administration & dosage*; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects* / Q000502:physiology
chemical_list: D018943:Anthracyclines; D000970:Antineoplastic Agents; D000068878:Trastuzumab
keywords: 2D echocardiography; Anthracyclines; Breast cancer; Cardiomyopathy