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Detection of early cardiac effects through strain rate imaging in patients undergoing breast cancer treatment with trastuzumab.


Sub-category:
HER2+

Category:
Breast Cancer - HER2/ER

Meeting:
2011 ASCO Annual Meeting

Abstract No:
e11093

Citation:
J Clin Oncol 29: 2011 (suppl; abstr e11093)


Publication-only abstracts (abstract number preceded by an "e"), published in conjunction with the 2011 Annual Meeting but not presented at the Meeting, can be found online only.

The publication-only abstracts are not included in the print or USB versions of the ASCO Annual Meeting Proceedings Part I, but they are citable to the Journal of Clinical Oncology as a supplement (see citation on left).

Author(s): V. Michalaki, G. Koutroulis, S. Gennatas, C. G. Gennatas; Oncology Clinic Areteion Hospital University of Athens, Athens, Greece; University of Athens, Athens, Greece; Areteion Hospital University of Athens, Athens, Greece


Abstract Disclosures


Abstract:

Background: Trastuzumab prolongs survival in patients with human epidermal growth factor receptor type 2-positive breast cancer. Sequential left ventricular (LV) ejection fraction (EF) assessment has been mandated to detect myocardial dysfunction. Changes in cardiac function induced by this therapy, however, are subtle and difficult to quantitate by conventional imaging methods. Doppler myocardial imaging-based velocity, strain, and strain rate measurements have been shown to sensitively quantify abnormalities in cardiac function in other settings. The aim of this study was to determine if sensitive indices of left ventricular (LV) dysfunction, specifically strain rate imaging, would be useful for addressing the early detection of trastuzumab mediated cardiotoxicity. Methods: In a pilot study, we examined 12 women (age 59.8 +/- 3.6 years) with breast cancer receiving 18 cycles of trastuzumab. Conventional and Doppler myocardial imaging echocardiography were obtained at baseline and every 3 months of treatment. Segmental peak systolic longitudinal and radial velocity, strain, and strain rate (SR) were measured. Results: There was no overall change in Left ventricular dimensions, ejection fraction, and systolic myocardial velocity. In contrast, a significant reduction in longitudinal and radial strain and strain rate was found after 9 cycles (longitudinal strain -12.8% +/- 2.2% vs baseline (P = .001); radial strain 29.3% +/- 7.1% vs 50.3% +/- 10.6%, P < .001 vs baseline). Changes in radial function appeared earlier and were more pronounced than in longitudinal direction. Conclusions: In contrast with conventional echocardiography myocardial velocity measurements allowed detecting subtle changes in longitudinal and radial left ventricular function after 9 cycles of trastuzumab. We suggest that strain rate imaging identifies preclinical myocardial dysfunction earlier than conventional measures in women undergoing treatment with trastuzumab for breast cancer and should be used for cardiac function monitoring.