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

Citation

Hare, JL and Brown, JK and Leano, R and Jenkins, C and Woodward, N and Marwick, TH, 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) pp. 294-301. ISSN 0002-8703 (2009) [Refereed Article]


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Copyright Statement

Copyright 2009 Mosby Inc.

DOI: doi:10.1016/j.ahj.2009.05.031

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 ≥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 ≥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.

Item Details

Item Type:Refereed Article
Research Division:Medical and Health Sciences
Research Group:Cardiorespiratory Medicine and Haematology
Research Field:Cardiology (incl. Cardiovascular Diseases)
Objective Division:Health
Objective Group:Clinical Health (Organs, Diseases and Abnormal Conditions)
Objective Field:Cardiovascular System and Diseases
Author:Marwick, TH (Professor Tom Marwick)
ID Code:90765
Year Published:2009
Web of Science® Times Cited:120
Deposited By:Menzies Institute for Medical Research
Deposited On:2014-04-23
Last Modified:2014-05-05
Downloads:0

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