Subclinical Myocardial Impairment Occurred in Septal and Anterior LV Wall Segments After Anthracycline-Embedded Chemotherapy and did not Worsen During Adjuvant Trastuzumab Treatment in Breast Cancer Patients

Abstract

In a previous study of breast cancer patients, we found changes in cardiac function and size during the early stages of adjuvant trastuzumab (Herceptin(®)) therapy. Here we present a subgroup analysis of this patient cohort. This subgroup received a anthracycline-embedded chemotherapy followed by at least 3 months up to 6 months of adjuvant Herceptin(®) therapy. Twenty-seven female breast cancer patients with Her-2/-neu overexpression were studied using conventional echocardiography and 2D speckle tracking. These methods were done before anthracycline-embedded chemotherapy, before adjuvant trastuzumab therapy, and both 3 and 6 months after the start of the therapy (T3, T6). The LV-EF (Simpson biplane) decreased significantly from before the chemotherapy to after the chemotherapy and further decreased after 3 months of trastuzumab therapy (66.2 ± 1.5 vs. 58.7 ± 1.2 vs. 55.6 ± 1.3 vs. 55.9 ± 1.5 %; p < 0.05). The stroke volume index remained constant after chemotherapy (22.0 ± 0.8 vs. 22.6 ± 1.3 ml/m(2); p = 0.9), but increased significantly during trastuzumab therapy (26.7 ± 1.1 and 27.3 ± 1.0 ml/m(2); p < 0.01). Global longitudinal strain exclusively decreased during chemotherapy (-21.0 ± 0.5 vs. -18.9 ± 0.5 %, p < 0.001). Regional longitudinal strain decreased significantly after chemotherapy in septal, anteroseptal, anterolateral, and apex segments. Mitral valve regurgitation increased during the whole treatment, but especially during trastuzumab. Right ventricular function decreased exclusively during chemotherapy. Anthracycline-embedded chemotherapy in patients with breast cancer led to a decrease in LV function, especially of the septal and anterior segments, and did not worsen during adjuvant trastuzumab treatment.

Global and regional patterns of longitudinal strain in screening for chemotherapy-induced cardiotoxicity

“…13 Our patient population was similar to those assessed in previous studies of cardiotoxicity in breast cancer patients, 14,15 suggesting that our data could be used to identify patients at high risk of developing CIC.…”

“…19 This finding is also in agreement with a previous study that reported decreased longitudinal strain in septal, anteroseptal, anterolateral and apical segments in 27 patients undergoing chemotherapy with anthracyclines. 15 While it needs to be confirmed in further studies, recognition of this pattern of septal and anterior involvement may prove useful when screening for chemotherapy-related cardiotoxicity.…”

Methods of diagnosis in cardio-oncology

“…(2016 г.) показали увеличение степени митральной регургитации на фоне химиотерапии, особенно при лечении трастузумабом [5]. Было показано, что при лечении антрациклинами достоверно ухудшается диастолическая функция ЛЖ.…”

“…Главным ориентиром в оценке кардиотоксичности все же остается ФВ. Доказано, что ФВ ЛЖ снижается как на фоне химиотерапии [4,5,9], так и лучевой терапии [10]. Однако снижение ФВ ЛЖ наблюдается чаще на поздних сроках после химиотерапии.…”

A bal kamra korszerű echokardiográfiás vizsgálata – az M-módtól a 3D speckle-tracking képalkotásig

“…A 2DSTE alkalmas lehet bizonyos esetekben kezelések (például kemoterápia) BK-ra kifejtett hatásának, esetleges mellékhatásainak vizsgálatára, továbbkövetéses vizsgálatok elvégzésére [27]. A módszer teoretikus előnye egyszerűsége, azonban hátránya, hogy csak egy adott síkban vizsgálja a BK-t.…”