Kalliopi Keramida1, Dimitrios Farmakis1,2, Jose Bingcang3, Samir Sulemane4, Stephanie Sutherland5, Roma A Bingcang3, Kanchana Ramachandran6, Chara Tzavara7, Georgios Charalampopoulos8, Dimitrios Filippiadis8, Nikolaos Kouris9, Petros Nihoyannopoulos4,10. 1. Cardio-Oncology Clinic, Heart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece. 2. University of Cyprus Medical School, Nicosia, Cyprus. 3. Barts Health NHS Trust and University College London Hospitals, London, UK. 4. Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK. 5. Mount Vernon Cancer Centre, West Hertfordshire Hospitals NHS Trust, London, UK. 6. Watford Hospital, West Hertfordshire Hospitals NHS Trust, London, UK. 7. Department of Hygiene, Epidemiology and Medical Statistics, Athens University Medical School, Athens, Greece. 8. 2nd Radiology Department, University General Hospital 'ATTIKON', Medical School, National and Kapodistrian University of Athens, Athens, Greece. 9. Cardiology Department, General Hospital of Elefsina Thriassio, Athens, Greece. 10. UK National Heart and Lung Institute, London, UK.
Abstract
BACKGROUND: Trastuzumab improves dramatically the prognosis of HER2-positive breast cancer patients, but it may lead to cardiotoxicity with left ventricular (LV) systolic dysfunction. Its effects on right ventricular (RV) function have not however been elucidated. We sought to assess LV and RV deformation mechanics during treatment with trastuzumab in breast cancer patients. METHODS AND RESULTS: We studied 101 consecutive women (mean age 54.3 ± 11.4 years) receiving trastuzumab for 12 months; 62 of them (61.4%) had previously received anthracyclines and 26 (25.7%) were receiving taxanes concurrently with trastuzumab. Comprehensive two-dimensional echocardiography with speckle tracking imaging of LV and RV global longitudinal strain (GLS) and RV free wall longitudinal strain (FWLS) analyses were performed at baseline and every 3 months up to treatment completion. Cardiotoxicity was defined as a decrease of baseline LV ejection fraction > 10 percentage units to a value < 50%. At 3 months, only LV GLS was significantly reduced (-19.5 ± 2.7 to -18.7 ± 2.8, P = 0.0410), while at 6 months, LV GLS, RV GLS and RV FWLS had significantly declined reaching their lowest values (-17.9 ± 6.1, P = 0.002, -19.6 ± 5.2, P = 0.003 and -19.7 ± 5.6, P = 0.004, respectively). Ten women (9.9%) developed cardiotoxicity. A RV GLS percent change of -14.8% predicted cardiotoxicity with 66.7% sensitivity and 70.8% specificity (area under the curve 0.68, 95% confidence interval 0.54-0.81), classifying correctly 90% of women with cardiotoxicity. This cut-off is quite similar to the 15% change of LV GLS previously suggested as predictive of cardiotoxicity. CONCLUSIONS: Deformation mechanics of both the left and right ventricle follow similar temporal pattern and degree of impairment during trastuzumab therapy, confirming the global and uniform effect of trastuzumab on myocardial function.
BACKGROUND:Trastuzumab improves dramatically the prognosis of HER2-positive breast cancerpatients, but it may lead to cardiotoxicity with left ventricular (LV) systolic dysfunction. Its effects on right ventricular (RV) function have not however been elucidated. We sought to assess LV and RV deformation mechanics during treatment with trastuzumab in breast cancerpatients. METHODS AND RESULTS: We studied 101 consecutive women (mean age 54.3 ± 11.4 years) receiving trastuzumab for 12 months; 62 of them (61.4%) had previously received anthracyclines and 26 (25.7%) were receiving taxanes concurrently with trastuzumab. Comprehensive two-dimensional echocardiography with speckle tracking imaging of LV and RV global longitudinal strain (GLS) and RV free wall longitudinal strain (FWLS) analyses were performed at baseline and every 3 months up to treatment completion. Cardiotoxicity was defined as a decrease of baseline LV ejection fraction > 10 percentage units to a value < 50%. At 3 months, only LV GLS was significantly reduced (-19.5 ± 2.7 to -18.7 ± 2.8, P = 0.0410), while at 6 months, LV GLS, RV GLS and RV FWLS had significantly declined reaching their lowest values (-17.9 ± 6.1, P = 0.002, -19.6 ± 5.2, P = 0.003 and -19.7 ± 5.6, P = 0.004, respectively). Ten women (9.9%) developed cardiotoxicity. A RV GLS percent change of -14.8% predicted cardiotoxicity with 66.7% sensitivity and 70.8% specificity (area under the curve 0.68, 95% confidence interval 0.54-0.81), classifying correctly 90% of women with cardiotoxicity. This cut-off is quite similar to the 15% change of LV GLS previously suggested as predictive of cardiotoxicity. CONCLUSIONS: Deformation mechanics of both the left and right ventricle follow similar temporal pattern and degree of impairment during trastuzumab therapy, confirming the global and uniform effect of trastuzumab on myocardial function.
Authors: José Luis Zamorano; Christer Gottfridsson; Riccardo Asteggiano; Dan Atar; Lina Badimon; Jeroen J Bax; Daniela Cardinale; Antonella Cardone; Elizabeth A M Feijen; Péter Ferdinandy; Teresa López-Fernández; Chris P Gale; John H Maduro; Javid Moslehi; Torbjørn Omland; Juan Carlos Plana Gomez; Jessica Scott; Thomas M Suter; Giorgio Minotti Journal: Eur J Heart Fail Date: 2020-10-02 Impact factor: 15.534
Authors: Markus S Anker; Sara Hadzibegovic; Alessia Lena; Yury Belenkov; Jutta Bergler-Klein; Rudolf A de Boer; Dimitrios Farmakis; Stephan von Haehling; Zaza Iakobishvili; Christoph Maack; Radek Pudil; Hadi Skouri; Alain Cohen-Solal; Carlo G Tocchetti; Andrew J S Coats; Petar M Seferović; Alexander R Lyon Journal: ESC Heart Fail Date: 2019-12-28