Question on Echo and Herceptin

Erin · 11-14-2007, 06:24 PM

Hello Ladies,

I just had my third echo done to check my heart function and it came back with LVEF of 55-60%. My first was 65% and my second was 64%. Does this indicate a significant drop? I know echos are not as precise as MUGAs, but I am a little worried since I have a very strong family history of heart disease and have some mitral valve regurgitation already.

My onc says since I have been on Herceptin for almost 10 months I have gotten 95% of the benefit from it already and he is confident it will not have an impact if I stop early. I am a very active person and am concerned about long-term impacts on my heart.

Any comments?

Erin · 11-15-2007, 11:09 AM

Bumping this up - hoping to get some replys :-)

AlaskaAngel · 11-15-2007, 11:32 AM

Erin,

That drop wouldn't be considered significant, although would be something watched more closely because of your history and family history. Per my onc, 50% would be the cutoff (which was given as the minimum for the clinical trial requirements to participate in a HER2 trial for adjuvant treatment). As well, the length of time of treatment is still sort of a rough estimate, and your onc's response is also quite reasonable.

AlaskaAngel

CPA · 11-15-2007, 11:39 AM

Most of the studies I have looked at show only a small % of patients do not get most or all of their LVEF back after discontinuing Herceptin. The fact that you did TCH instead of AC->TH also is in your favor since the combination of AC + H can apparently cause more permanent damage.

You are still in the "normal" LVEF range. Your onc is not recommending discontinuing Herceptin is he/she???

Did the same technician do the most recent echo?? As I unerstand, there is some room for interpretation of actual LVEF readings, which is why they often give a range. If you had a new tech, that could explain some of the difference.

Joan M · 11-16-2007, 10:42 PM

Hi Erin,

I'm not sure what 55%-60% means, or why there isn't just one number.

I was taken off Herceptin in October after a muga scan showed a decrease in my LVEF of greater than 10%, which my onc said is a guideline for discontinuing Herceptin, even though the normal range for a muga scan should be between 50% and 70%.

I went from 70% to 57%, from my first to second scans.

That's why I'm wondering about your range (55% to 60%). If your second scan was 64%, your scan shouldn't drop more than 6.4 percentage points, or lower than roughly 57%.

Your onc probably wants to discontinue Herceptin because your range is close to the 10% drop.

I was very upset about discontinuing Herceptin. I had resumed taking Herceptin when I became Stage IV this year, but had taken it for early stage BC for one year weekly without a problem (scans always in the low-to-mid 60% range).

My once said she doesn't want to run the risk of damaging my heart in case I have to start taking chemo again.

Alice · 11-17-2007, 11:02 AM

Hi,
I always had echos and not mugua. My echos started at 78% and when it dropped to 65% I stopped Herceptin early due to a 20% drop in the echo. My onc was not convinced that doing herceptin for more than 9 weeks was of any benefit. I feel comfortable with the decision. At the time of the drop in echo I was starting to get some simptoms from the drop in LV contraction and did not fell that the benefit from more herceptin was worth the risk of permanent damage to the heart. I think when they finish the studies on the length of time for the most benefit from herceptin, we will all feel better about our decissions.
Alice

Erin · 11-17-2007, 01:16 PM

Thanks to everyone for the advice :-)

ckeesling · 11-17-2007, 01:42 PM

Hi Erin,
I also have been having the echo's,I'm really not sure what the difference is between a muga and an echo. I have been on Herceptin since last Jan, and will complete infusion in late Dec. I was worried also about the possible heart damage due to my mother having cardio myiopathy and chf. My last one in Sept was holding steady at 65% and the onc claim this was good..
Take care
Cathy

chrisy · 11-17-2007, 02:53 PM

Hi Erin,
Coupla thoughts.

First, echo's are partly art - not precise science. The reading depends on the talent of the tech and the person who reads it. Hence your report saying "55-60". Is it 55? 60? "57.3"?" Abve 55 is considered "normal" and from the cardiologists perspective, that's what THEY look for. Our oncologists are looking for movement up or down and want exact numbers from an inexact procedure. But over 55 is still normal, and your heart will in all likelihood bounce back. My LVEF bounced up and down.

Second, I don't know if you're aware the timing of the test is important as it can fluctuate relative to when you get your Herceptin infusion. The "best" time to get tested is just before you get Herceptin.

Echo vs. muga - they measure different things. Echo measures the compression of the heart muscle, muga measures the flow of blood through the heart.

Good luck
Chris

Joan M · 11-20-2007, 07:02 AM

Chrisy,

Thanks for the explanation.

I was also wondering what the difference is between an echo and a muga.

In regard to protecting the heart, I agree with Alice that despite the Herceptin trials, it's still unclear just how long to take Herceptin before it's effective, and it's best to not run the risk of damaging the heart.

I was sent the following link which discusses whether Herceptin taken concurrently with Herceptin is just as effective at 9 weeks rather than at 52 weeks:

http://gilliansanson.wordpress.com/2...rceptin-facts/