title: Left Ventricular Global Longitudinal Strain in HER-2 + Breast Cancer Patients Treated with Anthracyclines and Trastuzumab Who Develop Cardiotoxicity Is Associated with Subsequent Recovery of Left Ventricular Ejection Fraction.
abstract: OBJECTIVE
  The combination of anthracyclines (AC) and trastuzumab (TRZ) is highly effective in patients with aggressive HER-2 + breast cancer, but has a significant risk of cardiotoxicity (CT). Trastuzumab-induced CT may be reversible. The aim of this study was to identify echocardiographic parameters associated with recovery of left ventricular ejection fraction (LVEF) in patients who developed CT after AC and TRZ treatment.
  
  
  RESULTS
  Women with newly diagnosed breast cancer treated with AC followed by TRZ and monitored with serial echocardiograms were retrospectively studied. Left ventricular end-diastolic and systolic volumes, LVEF, and global longitudinal strain (GLS) were examined. Development and reversibility of CT were defined based on changes in LVEF according to the 2014 ASE/EACVI recommendations. Cox analysis was used to determine the association of echocardiographic variables with the subsequent development and reversibility of CT. Ninety-five patients underwent 5 echocardiograms or more in a 17-month (13-28 months) follow-up period. Nineteen patients (20%) developed CT. Left ventricular volumes, LVEF, and GLS measured after AC completion identified the subsequent development of CT. Of the 19 patients with CT, the LVEF partially or fully recovered in 13 (68%). GLS at the time of CT diagnosis was associated with subsequent recovery of LVEF (P = 0.004).
  
  
  CONCLUSIONS
  In patients with breast cancer treated with AC and TRZ who develop CT, GLS at the time of CT diagnosis is associated with subsequent recovery of LVEF and may be useful for risk stratification and to guide treatment.
authors.affiliation: Cardiac Ultrasound Laboratory, Division of Cardiology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.|Division of Adult Echocardiography, Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital and Guangdong Academy of Medical Sciences, Guangzhou, China.
authors.forename: Hong-Wen
authors.initials: HW
authors.lastname: Fei
authors.affiliation: Cardiac Ultrasound Laboratory, Division of Cardiology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Mohammed T
authors.initials: MT
authors.lastname: Ali
authors.affiliation: Blacktown Clinical School, Department of Cardiology, Faculty of Medicine, University of Western Sydney, Sydney, NSW, Australia.|School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Tan
authors.affiliation: Cardiac Ultrasound Laboratory, Division of Cardiology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Kai-Hung
authors.initials: KH
authors.lastname: Cheng
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Laura
authors.initials: L
authors.lastname: Salama
authors.affiliation: Cardiac Ultrasound Laboratory, Division of Cardiology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Lanqi
authors.initials: L
authors.lastname: Hua
authors.affiliation: Cardiac Ultrasound Laboratory, Division of Cardiology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Xin
authors.initials: X
authors.lastname: Zeng
authors.affiliation: Institute for Technology Assessment, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Elkan F
authors.initials: EF
authors.lastname: Halpern
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Alphonse
authors.initials: A
authors.lastname: Taghian
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: MacDonald
authors.affiliation: Cardiac Ultrasound Laboratory, Division of Cardiology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Marielle
authors.initials: M
authors.lastname: Scherrer-Crosbie
mesh_terms: D018943:Anthracyclines; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism; D054715:Cardiotoxins / Q000009:adverse effects / Q000627:therapeutic use; D004452:Echocardiography / Q000379:methods*; D055119:Elastic Modulus / Q000187:drug effects; D054459:Elasticity Imaging Techniques / Q000379:methods; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D020127:Recovery of Function; D013318:Stroke Volume / Q000187:drug effects; D000068878:Trastuzumab / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000503:physiopathology*
chemical_list: D018943:Anthracyclines; D000970:Antineoplastic Agents; D054715:Cardiotoxins; D018719:Erb-b2 Receptor Tyrosine Kinases; D000068878:Trastuzumab; C508053:ERBB2 protein, human
keywords: cardiotoxicity; chemotherapy; echocardiography; global longitudinal strain