How does trastuzumab treatment affect the right ventricle in females with breast cancer?

Tadić, Marijana; Cuspidi, Cesare; Ivanović, Branislava

doi:10.5152/akd.2015.14349

Cited by 2 publications

(1 citation statement)

References 14 publications

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“…Initial studies evaluating trastuzumab induced RV dysfunction utilized 2D-echocardiography, which has limited accuracy in assessing RV size and function owing to its shape and position, and other inherent drawbacks including operator dependency and need for a good acoustic window for accurate measurements [ 29 ]. Furthermore, the results based on these echocardiography studies have been inconsistent [ 30 ]. Lange et al used 2D-echocardiography at baseline, 3 and 6 months after trastuzumab which showed no difference in global RV function [ 21 ], while Kilicaslan et al demonstrated a reduction in RV function at 6 months, similar to our results [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

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

Barthur

Brezden-Masley

Connelly

et al. 2016

Journal of Cardiovascular Magnetic Resonance

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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.

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