title: Cardiac monitoring in patients on trastuzumab: correlation of ultrasound and radionuclide ventriculography.
abstract: BACKGROUND
  Guidance on cardiac surveillance during adjuvant trastuzumab therapy remains elusive. The recommended methods are two-dimensional echocardiography (2D-ECHO) and electrocardiography gated equilibrium radionuclide ventriculography (RNV). We assessed the correlation and possible specific merits of these two methods.
  
  
  METHODS
  In a prospective cohort study in patients undergoing post-anthracycline adjuvant trastuzumab therapy, clinical assessment, 2D-ECHO and RNV were performed at baseline, 4, 8 and 12 months. The correlation between used methods was estimated with Pearson's correlation coefficient and Bland-Altman analysis.
  
  
  RESULTS
  Ninety-two patients (mean age 53.6±9.0 years) were included. The correlation of LVEF measured by ECHO and RNV at each time point was statistically insignificant. Values obtained by ECHO were on average higher (3.7% to 4.5%). A decline in LVEF of ≥10% from baseline was noticed in 19 (24.4%) and 13 (14.9%) patients with ECHO and RNV, respectively, however in only one patient by both methods simultaneously. A decline in LVEF of ≥10% to below 50% was found in three and none patients according to RNV and ECHO measurements, respectively.
  
  
  CONCLUSIONS
  There is a weak correlation of ECHO and RNV measurements in individual patient, the results obtained by the methods are not interchangeable. LVEF values determined by 2D-ECHO were on average higher compared to RNV determined ones. When in an asymptomatic patient a decline in LVEF requiring treatment interruption is detected by RNV ECHO re-evaluation and referral to a cardiologist is advised.
authors.affiliation: Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia - ematos@onko-i.si.
authors.forename: Erika
authors.initials: E
authors.lastname: Matos
authors.affiliation: Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia.
authors.forename: Borut
authors.initials: B
authors.lastname: Jug
authors.affiliation: Department of Nuclear Medicine, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
authors.forename: Barbara
authors.initials: B
authors.lastname: Vidergar Kralj
authors.affiliation: Department of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia.
authors.forename: Branko
authors.initials: B
authors.lastname: Zakotnik
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D066126:Cardiotoxicity / Q000000981:diagnostic imaging / Q000209:etiology; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D015331:Cohort Studies; D016903:Drug Monitoring / Q000379:methods; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D015635:Radionuclide Ventriculography / Q000379:methods*; D013997:Time Factors; D000068878:Trastuzumab / Q000008:administration & dosage / Q000009:adverse effects*; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced / Q000000981:diagnostic imaging; D016277:Ventricular Function, Left
chemical_list: D000970:Antineoplastic Agents; D000068878:Trastuzumab