Use of myocardial deformation imaging to detect preclinical myocardial dysfunction before conventional measures in patients undergoing breast cancer treatment with trastuzumab

Hare, J.L., Brown, J.K., Leano, R., Jenkins, C., Woodward, N. and Marwick, T.H. (2009) Use of myocardial deformation imaging to detect preclinical myocardial dysfunction before conventional measures in patients undergoing breast cancer treatment with trastuzumab. American Heart Journal, 158 2: 294-301. doi:10.1016/j.ahj.2009.05.031


Author Hare, J.L.
Brown, J.K.
Leano, R.
Jenkins, C.
Woodward, N.
Marwick, T.H.
Title Use of myocardial deformation imaging to detect preclinical myocardial dysfunction before conventional measures in patients undergoing breast cancer treatment with trastuzumab
Journal name American Heart Journal   Check publisher's open access policy
ISSN 0002-8703
Publication date 2009-08
Sub-type Article (original research)
DOI 10.1016/j.ahj.2009.05.031
Volume 158
Issue 2
Start page 294
End page 301
Total pages 8
Place of publication United States
Publisher Mosby
Collection year 2010
Language eng
Subject C1
920102 Cancer and Related Disorders
11 Medical and Health Sciences
Formatted 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 because of the risk of heart failure with this treatment. Myocardial deformation imaging is a sensitive means of detecting LV dysfunction, but this technique has not been evaluated in patients treated with trastuzumab. The aim of this study was to investigate whether changes in tissue deformation, assessed by myocardial strain and strain rate (SR), are able to identify LV dysfunction earlier than conventional echocardiographic measures in patients treated with trastuzumab.

METHODS
: Sequential echocardiograms (n = 152) were performed in 35 female patients (51 +/- 8 years) undergoing trastuzumab therapy for human epidermal growth factor receptor type 2-positive breast cancer. Left ventricular EF was measured by 2- and 3-dimensional (2D and 3D) echocardiography, and myocardial deformation was assessed using tissue Doppler imaging and 2D-based (speckle-tracking) strain and SR. Change over time was compared every 3 months between baseline and 12 months. RESULTS: There was no overall change in 3D-EF, 2D-EF, myocardial E-velocity, or strain. However, there were significant reductions seen in tissue Doppler imaging SR (P < .05), 2D-SR (P < .001), and 2D radial SR (P < .001). A drop > or =1 SD in 2D longitudinal SR was seen in 18 (51%) patients; 13 (37%) had a similar drop in radial SR. Of the 18 patients with reduced longitudinal SR, 3 had a concurrent reduction in EF > or =10%, and another 2 showed a reduction over 20 months follow-up.

CONCLUSIONS: Myocardial deformation identifies preclinical myocardial dysfunction earlier than conventional measures in women undergoing treatment with trastuzumab for breast cancer.

PMID: 19619708 [PubMed - indexed for MEDLINE]
Keyword Left-ventricular Assist
Anthracycline Treatment
Heart-failues
Adjuvant Chemotherapy
Dobutamine Stress
Echocardiography
Cardiotoxicity
Strain
Trial
Q-Index Code C1
Q-Index Status Confirmed Code

Document type: Journal Article
Sub-type: Article (original research)
Collections: 2010 Higher Education Research Data Collection
School of Medicine Publications
 
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Created: Thu, 08 Apr 2010, 14:32:24 EST by Fiona Mactaggart on behalf of Medicine - Princess Alexandra Hospital