Delayed contrast enhancement cardiac magnetic resonance imaging in trastuzumab induced cardiomyopathy

Abstract

BackgroundTrastuzumab (Herceptin), an antagonist to the human epidermal growth factor 2 (HER2) receptor significantly decreases the rates of breast cancer recurrence and mortality by 50%. Despite therapeutic benefits, the risk of cardiotoxicity with trastuzumab ranges from 10–15% when administered sequentially following anthraycline chemotherapy. Little is known about the utility of cardiac magnetic resonance (CMR) in the assessment of trastuzumab mediated cardiomyopathy.Methods and resultsBetween 2005–2006 inclusive, 160 breast cancer patients were identified at a single tertiary care oncology centre. Of the total population, 10 patients (mean age 40 ± 8 years) were identified with trastuzumab induced cardiomyopathy, based on a LVEF less than 40% on serial MUGA or echocardiography. CMR was performed in all patients to determine LV volumes, systolic function and evidence of late gadolinium enhancement (LGE). At the time of diagnosis of trastuzumab induced cardiomyopathy, the mean LVEF was 29 ± 4%. Subepicardial linear LGE was present in the lateral portion of the left ventricles in all 10 patients.ConclusionLGE-CMR is a novel way of detecting early changes in the myocardium due to trastuzumab induced cardiotoxicity.

Traditional and novel methods to assess and prevent chemotherapy-related cardiac dysfunction noninvasively

“…83 A characteristic pattern of mid myocardial hyperenhancement has been reported in breast cancer patients receiving trastuzumab who experienced LV dysfunction. 84 T1 weighted hyperenhancement within 3 days of the first anthracycline administration was associated with decreased LVEF on day 28 after starting chemotherapy. 85 Clinical trials of T1 weighted CMR imaging to assess cardiotoxicity and predict LV dysfunction and CHF appear warranted.…”

Cardiac magnetic resonance imaging-based myocardial strain study for evaluation of cardiotoxicity in breast cancer patients treated with trastuzumab: A pilot study to evaluate the feasibility of the method

“…Although its high cost and lack of availability precludes its routine clinical use, CMR has been validated for serial monitoring of LVEF and volume in patients with breast cancer receiving trastuzumab, as well as for the characterization of myocardial tissue changes [7,11,12]. Recently, CMR has been also used to monitor right ventricular (RV) ejection fraction (RVEF) in cardiotoxicity [13].…”

Trastuzumab and Cardiotoxicity

“…(Bovelli et al, 2010) Other echocardiographic techniques such as Doppler-derived parameters seem to show early changes in myocardial function in this setting. (Hare, 2009;Fallah-Rad, 2008).…”