Longitudinal assessment of right ventricular structure and function by cardiovascular magnetic resonance in breast cancer patients treated with trastuzumab: a prospective observational study

Journal of Cardiovascular Magnetic Resonance

Research

Ashita Barthur¹  Gauri R. Karur¹  Joseph J. Barfett²  Anish Kirpalani²  Djeven P. Deva²  Laura Jimenez-Juan³  Vinita Dhir⁴  Rashida Haq⁴  Christine Brezden-Masley⁵  Kim A. Connelly⁶  Andrew T. Yan⁶  Kelvin K. W. Chan⁷ 

[1] Department of Medical Imaging, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada;Department of Medical Imaging, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada;Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada;Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada;Division of Hematology/Oncology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada;Division of Hematology/Oncology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada;Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada;Keenan Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada;Terrence Donnelly Heart Centre, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada;Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada;Sunnybrook Health Sciences Centre, University of Toronto, Cancer Care Ontario, Canadian Center for Applied Research in Cancer Control, Toronto, ON, Canada;

关键词: Right ventricle;    Cardiovascular magnetic resonance;    Cardiotoxicity;    Trastuzumab;   

DOI  :  10.1186/s12968-017-0356-4

 received in 2016-12-07, accepted in 2017-04-03,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThere are limited data on the effects of trastuzumab on the right ventricle (RV). Therefore, we sought to evaluate the temporal changes in right ventricular (RV) structure and function as measured by cardiovascular magnetic resonance (CMR), and their relationship with left ventricular (LV) structure and function in breast cancer patients treated with trastuzumab.MethodsProspective, longitudinal, observational study involving 41 women with HER2+ breast cancer who underwent serial CMR at baseline, 6, 12, and 18 months after initiation of trastuzumab. A single blinded observer measured RV parameters on de-identified CMRs in a random order. Linear mixed models were used to investigate temporal changes in RV parameters.ResultsOf the 41 women (age 52 ± 11 years), only one patient experienced trastuzumab-induced cardiotoxicity. Compared to baseline, there were small but significant increases in the RV end-diastolic volume at 6 months (p = 0.002) and RV end-systolic volume at 6 and 12 months (p < 0.001 for both), but not at 18 months (p = 0.82 and 0.13 respectively). RV ejection fraction (RVEF), when compared to baseline (58.3%, 95% CI 57.1–59.5%), showed corresponding decreases at 6 months (53.9%, 95% CI 52.5–55.4%, p < 0.001) and 12 months (55%, 95% CI 53.8–56.2%, p < 0.001) that recovered at 18 months (56.6%, 95% CI 55.1–58.0%, p = 0.08). Although the temporal pattern of changes in LVEF and RVEF were similar, there was no significant correlation between RVEF and LVEF at baseline (r = 0.29, p = 0.07) or between their changes at 6 months (r = 0.24, p = 0.17).ConclusionIn patients receiving trastuzumab without overt cardiotoxicity, there is a subtle but significant deleterious effect on RV structure and function that recover at 18 months, which can be detected by CMR. Furthermore, monitoring of LVEF alone may not be sufficient in detecting early RV injury. These novel findings provide further support for CMR in monitoring early cardiotoxicity.Trial registrationClinicalTrials.gov Identifier: NCT01022086. Date of registration: November 27, 2009.

【 授权许可】

CC BY   
© The Author(s). 2017