Journal Article

Quantitative cardiovascular magnetic resonance findings and clinical risk factors predict cardiovascular outcomes in breast cancer patients

Henry, Mariana L., Sinusas, Albert, Lee, Seohyuk, Bader, Anna S., Arbune, Amit, Huber, Steffen, Lustberg, Maryam, Hull, Sarah, Wei, Wei, Baldassarre, Lauren A., Guha, Avirup, Kwan, Jennifer M., Nguyen, Vinh, Mojibian, Hamid, Peters, Dana, Hu, Rose, Lopez-Mattei, Juan, Meadows, Judith

2023

Overview

Cardiac magnetic resonance (CMR) global longitudinal strain and circumferential strain abnormalities have been associated with left ventricular ejection fraction (LVEF) reduction and cardiotoxicity from oncologic therapy. However, few studies have evaluated the associations of strain and cardiovascular outcomes. To assess CMR circumferential and global longitudinal strain (GLS) correlations with cardiovascular outcomes including myocardial infarction, systolic dysfunction, diastolic dysfunction, arrhythmias and valvular disease in breast cancer patients treated with and without anthracyclines and/or trastuzumab therapy. Breast cancer patients with a CMR from 2013-2017 at Yale New Haven Hospital were included. Patient co-morbidities, medications, and cardiovascular outcomes were obtained from chart review. Biostatistical analyses, including Pearson correlations, competing risk regression model, and competing risk survival curves comparing the two groups were analyzed. 116 breast cancer with CMRs were included in our analysis to assess differences between Anthracycline/Trastuzumab (AT) (62) treated versus non anthracycline/trastuzumab (NAT) (54) treated patients in terms of imaging characteristics and outcomes. More AT patients 17 (27.4%) developed systolic heart failure compared to the NAT group 6 (10.9%), p = 0.025. Statin use was associated with a significant reduction in future arrhythmias (HR 0.416; 95% CI 0.229-0.755, p = 0.004). In a sub-group of 13 patients that underwent stress CMR, we did not find evidence of microvascular dysfunction by sub-endocardial/sub-epicardial myocardial perfusion index ratio after adjusting for ischemic heart disease. In our study, CMR detected signs of subclinical cardiotoxicity such as strain abnormalities despite normal LV function and abnormal circumferential strain was associated with adverse cardiovascular outcomes such as valvular disease and systolic heart failure. Thus, CMR is an important tool during and after cancer treatment to identity and prognosticate cancer treatment-related cardiotoxicity.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Abnormalities / Anthracycline / Arrhythmias, Cardiac - chemically induced / Bandwidths / Breast cancer / Breast Neoplasms - chemically induced / Breast Neoplasms - complications / Breast Neoplasms - drug therapy / Cancer / Cancer therapies / Cardiomyopathy / Cardiotoxicity / Cardiotoxicity - etiology / Cardiovascular disease / Cardiovascular diseases / Cardiovascular Diseases - chemically induced / Chemotherapy / Circumferences / Complications and side effects / Congestive heart failure / Contrast agents / Correlation / Diagnosis / Drug therapy / Ejection fraction / Female / Health risks / Health services / Heart diseases / Heart Failure, Systolic / Heart Valve Diseases / Humans / Immunotherapy / Ischemia / Magnetic resonance / Magnetic resonance imaging / Magnetic Resonance Imaging, Cine - methods / Magnetic Resonance Spectroscopy / Medicine and Health Sciences / Microvasculature / Monoclonal antibodies / Myocardial infarction / Patients / Prognosis / Reduction / Regression models / Research and Analysis Methods / Risk Factors / Stroke Volume / Targeted cancer therapy / Trastuzumab / Trastuzumab - adverse effects / Ventricle / Ventricular Dysfunction, Left / Ventricular Function, Left