title: Evaluation of Trastuzumab-induced early cardiac dysfunction using two-dimensional Strain Echocardiography.
abstract: OBJECTIVE
  Trastuzumab, a chemotherapeutic agent used in the treatment of breast cancer. has been shown to induce subclinical left ventricular (LV) dysfunction during a three to six month period as evidenced by strain echocardiographic examination without any change occurring in the ejection fraction of LV. The present study evaluated the presence of subclinical LV dysfunction using strain echocardiography 1 day and 7 days after the initiation of trastuzumab therapy.
  
  
  METHODS
  The patients with breast cancer receiving adjuvant trastuzumab therapy underwent 2-dimensional, tissue Doppler, and strain echocardiographic examination at baseline and 1 day and 7 days after therapy. LV global longitudinal strain (GLS), global circumferential strain (GCS) values, and other echocardiographic parameters were calculated.
  
  
  RESULTS
  A total of 40 females, mean age 50+/-10 years, were evaluated. Of these patients, 97% received anthracycline and 73% received radiotherapy before the initiation of trastuzumab therapy. No change was observed in any of the echocardiographic parameters 1 day after the initiation of trastuzumab therapy (p>0.05). The LV ejection fraction, tissue Doppler parameters, and GCS values did not show any changes 7 days after the initiation of therapy, whereas significant decreases were observed in GLS value (19.2+/-4.0% vs. 17.2+/-3.4, p=0.001) and systolic annular velocity of the lateral LV wall (S' velocity) (10.5+/-3.2 vs. 8.6+/-2.2, p=0.002).
  
  
  CONCLUSIONS
  Trastuzumab therapy is associated with subclinical LV dysfunction as early as 7 days after initiation of the therapy as evidenced by the decreases in GLS value of LV and systolic annular velocity of the lateral LV wall.
authors.affiliation: Afyonkarahisar State Hospital, Department of Cardiology, Izmir, Turkey. vemren@hotmail.com.
authors.forename: Sadik Volkan
authors.initials: SV
authors.lastname: Emren
authors.affiliation: Katip Celebi University Ataturk Training and Research Hospital, Department of Cardiology, Izmir, Turkey.
authors.forename: Selcen Yakar
authors.initials: SY
authors.lastname: Tuluce
authors.affiliation: Katip Celebi University Ataturk Training and Research Hospital, Department of Cardiology, Izmir, Turkey.
authors.forename: Fatih
authors.initials: F
authors.lastname: Levent
authors.affiliation: Tepecik Training and Research Hospital, Department of Cardiology, Izmir, Turkey.
authors.forename: Kamil
authors.initials: K
authors.lastname: Tuluce
authors.affiliation: Katip Celebi University Ataturk Training and Research Hospital, Department of Internal Medicine, Izmir, Turkey.
authors.forename: Toygar
authors.initials: T
authors.lastname: Kalkan
authors.affiliation: Katip Celebi University Ataturk Training and Research Hospital, Department of Medical Oncology, Izmir, Turkey.
authors.forename: Yasar
authors.initials: Y
authors.lastname: Yildiz
authors.affiliation: Katip Celebi University Ataturk Training and Research Hospital, Department of Medical Oncology, Izmir, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Alacacioğlu
authors.affiliation: Katip Celebi University Ataturk Training and Research Hospital, Department of Medical Oncology, Izmir, Turkey.
authors.forename: Yüksel
authors.initials: Y
authors.lastname: Kucukzeybek
authors.affiliation: Katip Celebi University Ataturk Training and Research Hospital, Department of Medical Oncology, Izmir, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Akyol
authors.affiliation: Katip Celebi University Ataturk Training and Research Hospital, Department of Medical Oncology, Izmir, Turkey.
authors.forename: Tarık
authors.initials: T
authors.lastname: Salman
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy; D004452:Echocardiography / Q000187:drug effects / Q000379:methods*; D054459:Elasticity Imaging Techniques / Q000187:drug effects / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000187:drug effects; D000068878:Trastuzumab / Q000009:adverse effects* / Q000627:therapeutic use; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000000981:diagnostic imaging*
chemical_list: D000970:Antineoplastic Agents; D000068878:Trastuzumab