Geraldine Ong1, Christine Brezden-Masley2, Vinita Dhir3, Djeven P Deva4, Kelvin K W Chan5, Chi-Ming Chow6, Dinesh Thavendiranathan7, Rashida Haq8, Joseph J Barfett9, Teresa M Petrella10, Kim A Connelly11, Andrew T Yan12. 1. Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, ON, Canada. 2. Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, ON, Canada; Division of Hematology/Oncology, St Michael's Hospital, Toronto, ON, Canada. Electronic address: BrezdenC@smh.ca. 3. Division of Hematology/Oncology, St Michael's Hospital, Toronto, ON, Canada. Electronic address: vdhir@edu.uwaterloo.ca. 4. University of Toronto, Toronto, ON, Canada; Department of Medical Imaging, St. Michael's Hospital, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. Electronic address: devad@smh.ca. 5. 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. Electronic address: kelvin.chan@sunnybrook.ca. 6. Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada. Electronic address: Chowcm@smh.ca. 7. University of Toronto, Toronto, ON, Canada; Toronto General Hospital, University Health Network, Toronto, ON, Canada. Electronic address: Dinesh.Thavendiranathan@uhn.ca. 8. Division of Hematology/Oncology, St Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada. Electronic address: HAQR@smh.ca. 9. University of Toronto, Toronto, ON, Canada; Department of Medical Imaging, St. Michael's Hospital, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. Electronic address: barfettj@smh.ca. 10. University of Toronto, Toronto, ON, Canada; Sunnybrook Health Sciences Centre, Toronto, ON, Canada. Electronic address: Teresa.Petrella@sunnybrook.ca. 11. Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. Electronic address: connellyk@smh.ca. 12. Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada; Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada. Electronic address: yana@smh.ca.
Abstract
BACKGROUND: Our objectives were to evaluate the temporal changes in CMR-based strain imaging, and examine their relationship with left ventricular ejection fraction (LVEF), in patients treated with trastuzumab. PATIENTS AND METHODS: In this prospective longitudinal observational study, 41 women with HER2+ breast cancer treated with chemotherapy underwent serial CMR (baseline, 6, 12, and 18 months) after initiation of trastuzumab (treatment duration 12 months). LVEF and LV strain (global longitudinal[GLS] and circumferential[GCS]) measurements were independently measured by 2 blinded readers. RESULTS: Of the 41 patients, 56% received anthracycline-based chemotherapy. Compared to baseline (60.4%, 95%CI 59.2-61.7%), there was a small but significant reduction in LVEF at 6 months (58.4%, 95%CI 56.7-60.0%, p = 0.034) and 12 months (57.9%, 95%CI 56.4-59.7%, p = 0.012), but not at 18 months (60.2%, 95%CI 58.2-62.2%, p = 0.93). Similarly, compared to baseline, GLS and GCS decreased significantly at 6 months (p = 0.024 and < 0.001, respectively) and 12 months (p = 0.002 and < 0.001, respectively) with an increase in LV end-diastolic volume, but not at 18 months. There were significant correlations between the temporal (6 month-baseline) changes in LVEF, and all global strain measurements (Pearson's r = -0.60 and r = -0.75 for GLS and GCS, respectively, all p < 0.001). CONCLUSION: There was a significant reduction in LV strain during trastuzumab treatment, which correlated with a concurrent subtle decline in LVEF and was associated with an increase in LV end-diastolic volume. LV strain assessment by CMR may be a promising method to monitor for subclinical myocardial dysfunction in breast cancer patients receiving chemotherapy. Future studies are needed to determine its prognostic and therapeutic implications.
BACKGROUND: Our objectives were to evaluate the temporal changes in CMR-based strain imaging, and examine their relationship with left ventricular ejection fraction (LVEF), in patients treated with trastuzumab. PATIENTS AND METHODS: In this prospective longitudinal observational study, 41 women with HER2+ breast cancer treated with chemotherapy underwent serial CMR (baseline, 6, 12, and 18 months) after initiation of trastuzumab (treatment duration 12 months). LVEF and LV strain (global longitudinal[GLS] and circumferential[GCS]) measurements were independently measured by 2 blinded readers. RESULTS: Of the 41 patients, 56% received anthracycline-based chemotherapy. Compared to baseline (60.4%, 95%CI 59.2-61.7%), there was a small but significant reduction in LVEF at 6 months (58.4%, 95%CI 56.7-60.0%, p = 0.034) and 12 months (57.9%, 95%CI 56.4-59.7%, p = 0.012), but not at 18 months (60.2%, 95%CI 58.2-62.2%, p = 0.93). Similarly, compared to baseline, GLS and GCS decreased significantly at 6 months (p = 0.024 and < 0.001, respectively) and 12 months (p = 0.002 and < 0.001, respectively) with an increase in LV end-diastolic volume, but not at 18 months. There were significant correlations between the temporal (6 month-baseline) changes in LVEF, and all global strain measurements (Pearson's r = -0.60 and r = -0.75 for GLS and GCS, respectively, all p < 0.001). CONCLUSION: There was a significant reduction in LV strain during trastuzumab treatment, which correlated with a concurrent subtle decline in LVEF and was associated with an increase in LV end-diastolic volume. LV strain assessment by CMR may be a promising method to monitor for subclinical myocardial dysfunction in breast cancerpatients receiving chemotherapy. Future studies are needed to determine its prognostic and therapeutic implications.
Authors: Srilakshmi Vallabhaneni; Kathleen W Zhang; Jose A Alvarez-Cardona; Joshua D Mitchell; Henning Steen; Pamela K Woodard; Daniel J Lenihan Journal: Int J Cardiovasc Imaging Date: 2021-05-12 Impact factor: 2.357
Authors: Yoo Jin Hong; Gun Min Kim; Kyunghwa Han; Pan Ki Kim; Su An Lee; Eunkyung An; Ji Yeon Lee; Hye-Jeong Lee; Jin Hur; Young Jin Kim; Min Jung Kim; Byoung Wook Choi Journal: BMC Cardiovasc Disord Date: 2020-06-03 Impact factor: 2.298