Clinical InvestigationLeft and Right Ventricular Deformation in Diverse DisordersIndependent and Incremental Value of Deformation Indices for Prediction of Trastuzumab-Induced Cardiotoxicity
Section snippets
Study Population
We enrolled 93 consecutive women receiving trastuzumab as part of their treatment for breast cancer at Cleveland Clinic (Cleveland, OH), and the University of Queensland (Brisbane, Australia). All patients underwent at least three echocardiographic studies (at baseline and at 6 and 12 months). Because β-blockers may have protective effect on chemotherapy-induced cardiomyopathy, 12 patients taking β-blockers were excluded from the analysis. The final population therefore comprised 81 patients
Patient Characteristics
Clinical characteristics are summarized in Table 1. Of the entire population, 37 patients (46%) received anthracycline sequentially with trastuzumab. Twenty-four women (30%) developed cardiotoxicity at 12 months. Baseline cardiac risk factors of both groups were similar. There were no differences in the staging of breast cancer, surgery, radiation, or the use of taxanes among the two groups. The maximal cumulative doses of anthracyclines (doxorubicin, 240 mg/m2; epirubicin, 600 mg/m2) were not
Discussion
The results of this study show that deformation parameters can provide added value to clinical parameters and baseline EF in the prognostication of subsequent reductions of EF in patients undergoing treatment with potentially cardiotoxic agents. In addition, this study shows that longitudinal strain is the most sensitive and robust predictor of early toxicity and subsequent EF decrease during trastuzumab therapy, compared with circumferential or radial strain. This study builds on the previous
Acknowledgments
We gratefully acknowledge the sonographers at Cleveland Clinic and at Princess Alexandra Hospital, as well as Danielle M. Brennan and Petr Otahal for statistical advice.
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Drs. K. Negishi and T. Negishi contributed equally to this study.