Document Detail


Echocardiography signs of early cardiac impairment in patients with breast cancer and trastuzumab therapy.
MedLine Citation:
PMID:  22249492     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Recent studies in breast cancer patients and Trastuzumab therapy (Herceptin) showed a development of a toxic cardiomyopathy as a severe complication. The aim of this study was to discover early changes in cardiac function and morphology.
METHODS: We studied 42 female patients with Her-2/-neu over-expression in breast cancer by echocardiography before, 3, and 6 months after start of the adjuvant Herceptin therapy. All values were mean value ± standard deviation.
RESULTS: After 3 or 6 months of a trastuzumab therapy we discovered significant increases in the diastolic and systolic left ventricle volume indices (LV-DVI 32.4 ± 8.5 vs. 38.5 ± 8.7 vs. 40.3 ± 10.3 ml/m², p < 0.001 and LV-SVI 12.6 ± 4.0 vs. 15.7 ± 4.7 vs. 17.2 ± 6.8 ml/m², p < 0.001), an increase of the end-diastolic and end-systolic LV diameter (LVEDD 46.8 ± 4.2 vs. 48.0 ± 4.7 vs. 49.7 ± 4.5 ml/m², p < 0.01; LVESD 28.3 ± 4.2 vs. 31.0 ± 4.7 vs. 32.3 ± 4.9 mm, p < 0.001), a reduced systolic ventricle function determined by the tissue Doppler imaging (TDI) velocity (9.2 ± 2.5 vs. 8.0 ± 1,7 vs. 7.7 ± 1.5 cm/s, p < 0.001), fractional shortening (39,6 ± 7.5 vs. 35.4 ± 7.4 vs. 35.2 ± 7.0%, p < 0.01), and the LV-EF Simpson biplane [62.0 ± 5.1 vs. 60.1 ± 6.3 (p = ns) vs. 58.4 ± 7.9%, p < 0.01] compared to pretreatment values. There was also an increase of the left atrial volume index (21.4 ± 6.2 vs. 26.2 ± 7.9 vs. 29.7 ± 8.8 ml/m², p < 0.001), a decrease of the median TDI atrial velocities (11.9 ± 2.4 vs. 10.5 ± 2.8 vs. 10.1 ± 2.1 cm/s, p < 0.01), an increase of the peak early diastolic filling velocities (73.1 ± 15.4 vs. 83.1 ± 16.4 vs. 82.2 ± 19.4 cm/s, p < 0.05), and an increase of the median mitral valve insufficiency degree (0.64 ± 0.65 vs. 1.03 ± 0.76 vs. 1.11 ± 0.73°, p < 0.001). We could not detect a significant increase in diastolic dysfunction. Also right heart diameters and function did not change significantly. Most patients stayed in an asymptomatic stage of cardiac disease.
CONCLUSION: The blockade of Her2/-neu receptors with trastuzumab in patients with breast cancer led to measurable alterations of left ventricular volume, left atrial volume, and systolic function as early as 3 months after start of treatment.
Authors:
Stefan A Lange; Bernd Ebner; Astrid Wess; Matthias Kögel; Mieczyslaw Gajda; Thomas Hitschold; Jens Jung
Publication Detail:
Type:  Journal Article     Date:  2012-01-17
Journal Detail:
Title:  Clinical research in cardiology : official journal of the German Cardiac Society     Volume:  101     ISSN:  1861-0692     ISO Abbreviation:  Clin Res Cardiol     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-05-16     Completed Date:  2012-09-21     Revised Date:  2013-05-08    
Medline Journal Info:
Nlm Unique ID:  101264123     Medline TA:  Clin Res Cardiol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  415-26     Citation Subset:  IM    
Affiliation:
Medizinische Klinik I, Kardiologie und Angiologie, Klinikum Worms, Akademisches Lehrkrankenhaus der Johannes-Gutenberg-Universität, Mainz, Germany. StefanAndreas.Lange@googlemail.com
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Antibodies, Monoclonal, Humanized / adverse effects*,  therapeutic use
Antineoplastic Agents / adverse effects*,  therapeutic use
Atrial Function, Left / drug effects
Breast Neoplasms / drug therapy*,  pathology
Cardiomyopathies / chemically induced*,  physiopathology,  ultrasonography
Chemotherapy, Adjuvant / adverse effects,  methods
Echocardiography, Doppler / methods
Female
Follow-Up Studies
Humans
Middle Aged
Prospective Studies
Receptor, erbB-2 / antagonists & inhibitors,  genetics
Systole / drug effects
Time Factors
Ventricular Function, Left / drug effects
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal, Humanized; 0/Antineoplastic Agents; EC 2.7.10.1/Receptor, erbB-2; P188ANX8CK/trastuzumab

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