Journal Article

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

Kirpalani, Anish, Brezden-Masley, Christine, Yan, Andrew T., Dhir, Vinita, Chan, Kelvin K.W., Barthur, Ashita, Deva, Djeven P., Haq, Rashida, Karur, Gauri R., Connelly, Kim A., Jimenez-Juan, Laura, Barfett, Joseph J.

2017

Overview

There 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. Prospective, 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. Of 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). In 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. ClinicalTrials.gov Identifier: NCT01022086. Date of registration: November 27, 2009.

• Publisher: Elsevier Inc,BioMed Central,BioMed Central Ltd,Elsevier
• Subject: Acute coronary syndromes / Adult / Analysis of Variance / Angiology / Antineoplastic Agents, Immunological - adverse effects / Breast cancer / Breast Neoplasms - drug therapy / Cancer / Cancer therapies / Cardiology / Cardiotoxicity / Cardiovascular magnetic resonance / Care and treatment / Chemotherapy / Diagnosis / Drug therapy / Early Diagnosis / ErbB-2 protein / Female / Heart / Heart Ventricles - diagnostic imaging / Heart Ventricles - drug effects / Heart Ventricles - pathology / Heart Ventricles - physiopathology / Humans / Imaging / Immunotherapy / Linear Models / Longitudinal Studies / Magnetic resonance / Magnetic resonance imaging / Magnetic Resonance Imaging, Cine / Medicine / Medicine & Public Health / Middle Aged / Monitoring / Monoclonal antibodies / Observational studies / Ontario / Parameter identification / Patients / Predictive Value of Tests / Prospective Studies / Radiology / Recovery of Function / Right ventricle / Single-Blind Method / Stroke Volume - drug effects / Structure-function relationships / Targeted cancer therapy / Task forces / Time Factors / Trastuzumab / Trastuzumab - adverse effects / Treatment Outcome / Ventricle / Ventricular Dysfunction, Right - chemically induced / Ventricular Dysfunction, Right - diagnostic imaging / Ventricular Dysfunction, Right - pathology / Ventricular Dysfunction, Right - physiopathology / Ventricular Function, Left - drug effects / Ventricular Function, Right - drug effects / Womens health