title: Cardiac magnetic resonance imaging-based myocardial strain study for evaluation of cardiotoxicity in breast cancer patients treated with trastuzumab: A pilot study to evaluate the feasibility of the method.
abstract: BACKGROUND
  Trastuzumab, used to treat breast cancer overexpressing human epidermal growth factor receptor 2, may be cardiotoxic. Cardiac magnetic resonance (CMR) imaging with myocardial strain studies has been used to evaluate subclinical biventricular myocardial changes, however, its clinical utility during chemotherapy has not been evaluated.
  
  
  METHODS
  The clinical outcomes, CMR and cardiac biomarkers of 9 women aged 62.3 ± 12.6 years with early or locally advanced breast cancer were evaluated at baseline, and at 3, 6 and 12 months after the initiation of trastuzumab.
  
  
  RESULTS
  None of the patients developed heart failure or elevated serum cardiac biomarkers. Global left ventricular (LV) peak systolic longitudinal and circumferential strains were significantly decreased at 6 months (longitudinal strains, -21.1 ± 1.7% [baseline] vs. -19.5 ± 1.0% [6 months], p = 0.039, and circumferential strains, -23.4 ± 1.8% [baseline] vs. -21.6 ± 2.5% [6 months], p = 0.036). These changes were analogous to those observed in the LV ejection fraction. Right ventricular (RV) free wall peak systolic circumferential strains were decreased at 6 months (-20.9% ± 2.4% [baseline] vs. -19.1% ± 2.3% [6 months], p = 0.049), whereas RV longitudinal strains and ejection fraction remained unchanged. The LV longitudinal strain was the most reproducible of the 4 peak strain parameters.
  
  
  CONCLUSIONS
  The LV longitudinal and circumferential strains measured by CMR decreased during trastuzumab therapy, although their predictive value for later heart failure or association with RV parameters was not determined. These techniques may be a useful means of diagnosing and monitoring trastuzumab-related cardiotoxicity.
authors.affiliation: Department of Cardiology, International Medical Center, Saitama Medical University, Saitama, Japan. snakano@saitama-med.ac.jp.
authors.forename: Shintaro
authors.initials: S
authors.lastname: Nakano
authors.forename: Masahiro
authors.initials: M
authors.lastname: Takahashi
authors.forename: Fumiko
authors.initials: F
authors.lastname: Kimura
authors.forename: Taiki
authors.initials: T
authors.lastname: Senoo
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Saeki
authors.forename: Shigeto
authors.initials: S
authors.lastname: Ueda
authors.forename: Jun
authors.initials: J
authors.lastname: Tanno
authors.forename: Takaaki
authors.initials: T
authors.lastname: Senbonmatsu
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Kasai
authors.forename: Shigeyuki
authors.initials: S
authors.lastname: Nishimura
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy*; D066126:Cardiotoxicity; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D010865:Pilot Projects; D012189:Retrospective Studies; D013318:Stroke Volume; D000068878:Trastuzumab / Q000009:adverse effects* / Q000627:therapeutic use; D016277:Ventricular Function, Left / Q000187:drug effects*
chemical_list: D000970:Antineoplastic Agents; D000068878:Trastuzumab
keywords: breast cancer; cardiac magnetic resonance; cardiotoxicity; myocardial strain; trastuzumab