Temporal Trends of Cardiac Chambers Function with Trastuzumab in Human Epidermal Growth Factor Receptor II-Positive Breast Cancer Patients.
BACKGROUND
Trastuzumab has substantially improved overall survival and reduced the risk of disease recurrence in patients with human epidermal growth factor receptor type II (HER-II)-positive breast cancer. However, this benefit may be at the increased risk of cardiotoxicity. We aimed to explore the early subclinical left and right ventricular as well as atrial dysfunction, in trastuzumab-treated patients with HER-II-positive breast cancer, using velocity vector imaging.


METHODS
Echocardiography images were acquired in 50 patients with HER-II-positive breast cancer undergoing trastuzumab therapy. All patients had baseline and 3-6 months and 12-15 months of follow-up echocardiograms after initiation of trastuzumab therapy. Subendocardial borders of all the cardiac chambers were traced from the apical views to obtain volumetric and deformation indices.


RESULTS
Mean age was 60 ± 13 years. Left ventricular (LV) ejection fraction as well as conventional indices of right ventricular (RV) function did not change with trastuzumab. The RV peak systolic global longitudinal strain (GLε) significantly decreased (-24.53 ± 6.03 vs. -21.28 ± 5.11 vs. -21.84 ± 5.15, baseline vs. first and second follow-ups, P = 0.01). LV peak systolic GLε was reduced by 1.19 at early follow-up (P < 0.05). Left atrial reservoir and booster pump functions as well as right atrial reservoir function were reduced through follow-up as well.


CONCLUSIONS
The RV exhibited greater change in strain after trastuzumab treatment when compared to the LV. Atria function was reduced by trastuzumab as well. The repercussion of these findings and their potential implication will warrant further study.
Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona.
Sherif
S
Moustafa
Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona.
Katie
K
Murphy
Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona.
Bhargava K
BK
Nelluri
Division of Hematology/Oncology, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona.
Donald
D
Northfelt
Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona.
Parth
P
Shah
Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona.
Howard
H
Lee
Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona.
Susan
S
Wilansky
Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona.
Tasneem Z
TZ
Naqvi
Division of Hematology/Oncology, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona.
Susan
S
Meyer
Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona.
Farouk
F
Mookadam
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000378:metabolism; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000187:drug effects; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008875:Middle Aged; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000187:drug effects; D000068878:Trastuzumab / Q000008:administration & dosage* / Q000009:adverse effects*; D016896:Treatment Outcome; D018754:Ventricular Dysfunction / Q000139:chemically induced* / Q000000981:diagnostic imaging*
D000970:Antineoplastic Agents; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab; C508053:ERBB2 protein, human
HER-II-positive; breast cancer; cardiac chambers function; trastuzumab; velocity vector imaging