The Utility of Cardiac Biomarkers, Tissue Velocity and Strain Imaging, and Cardiac Magnetic Resonance Imaging in Predicting Early Left Ventricular Dysfunction in Patients With Human Epidermal Growth Factor Receptor II-Positive Breast Cancer Treated With Adjuvant Trastuzumab Therapy

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:57

Article

Fallah-Rad, Nazanin²  Walker, Jonathan R.²  Lytwyn, Matthew²  Bohonis, Sheena²  Fang, Tielan²  Tian, Ganhong⁵  Kirkpatrick, Iain D. C.³  Singal, Pawan K.²  Krahn, Marianne⁴  Grenier, Debjani⁴  Jassal, Davinder S.^1,2,3,5 

[1] Univ Manitoba, St Boniface Gen Hosp, Dept Internal Med, Bergen Cardiac Care Ctr,Cardiol Sect,Cardiol Div, Winnipeg, MB R2H 2A6, Canada

[2] Univ Manitoba, St Boniface Gen Hosp, Inst Cardiovasc Sci, Winnipeg, MB R2H 2A6, Canada

[3] Univ Manitoba, Dept Radiol, Winnipeg, MB R2H 2A6, Canada

[4] Univ Manitoba, Dept Internal Med, Div Oncol, Winnipeg, MB R2H 2A6, Canada

[5] Natl Res Council Canada, Inst Biodiagnost, Winnipeg, MB R3B 1Y6, Canada

关键词: biomarkers;    breast cancer;    cardiac MRI;    cardiomyopathy;    doxorubicin;    strain;    tissue velocity imaging;    trastuzumab;   

DOI  :  10.1016/j.jacc.2010.11.063

来源: Elsevier

【 摘 要 】

Objectives The aim of this study was to evaluate whether cardiac biomarkers, tissue velocity (TVI) and strain imaging, and cardiac magnetic resonance imaging can predict early left ventricular (LV) dysfunction in human epidermal growth factor receptor II-positive breast cancer patients treated with trastuzumab in the adjuvant setting. Background Early indexes of LV systolic dysfunction with noninvasive cardiac imaging would be useful for addressing the cardiac safety profile of trastuzumab, potentially avoiding the detrimental effects of heart failure. Methods We used cardiac biomarkers, TVI and strain imaging, and cardiac magnetic resonance imaging to detect pre-clinical changes in LV systolic function, before conventional changes in left ventricular ejection fraction (LVEF) in human epidermal growth factor receptor II-positive breast cancer patients treated with trastuzumab in the adjuvant setting. Results Of 42 patients (mean age 47 +/- 9 years) prospectively followed between 2007 and 2009, 10 (25%) developed trastuzumab-mediated cardiomyopathy (CM). Troponin T, C-reactive protein, and brain natriuretic peptide did not change over time. Within 3 months of adjuvant therapy with trastuzumab, there was a significant difference in the lateral S' between the normal cohort and the CM group (9.1 +/- 1.6 cm/s and 6.4 +/- 0.6 cm/s, respectively, p < 0.05). Similarly, the peak global longitudinal and radial strain decreased as early as 3 months in the trastuzumab-mediated cardiotoxicity group. As compared with both global longitudinal and radial strain, only S' was able to identify all 10 patients who developed trastuzumab-mediated CM. The LVEF subsequently decreased at 6 months of follow-up in all 10 patients, necessitating discontinuation of the drug. All 10 patients demonstrated delayed enhancement of the lateral wall of the LV within the mid-myocardial portion, consistent with trastuzumab-induced CM. Conclusions Both TVI and strain imaging were able to detect pre-clinical changes in LV systolic function, before conventional changes in LVEF, in patients receiving trastuzumab in the adjuvant setting. (J Am Coll Cardiol 2011; 57: 2263-70) (C) 2011 by the American College of Cardiology Foundation

【 授权许可】

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