Sawaya, Heloisa Sebag, Igal A Plana, Juan Carlos Januzzi, James L
Ky, Bonnie Cohen, Victor Gosavi, Sucheta Carver, Joseph R Wiegers,
Susan E Martin, Randolph P Picard, Michael H Gerszten, Robert E Halpern,
Elkan F Passeri, Jonathan Kuter, Irene Scherrer-Crosbie, Marielle
K23 HL095661-02/HL/NHLBI NIH HHS/ Am J Cardiol. 2011 May 1;107(9):1375-80.
Epub 2011 Mar 2.
As breast cancer survival increases, cardiotoxicity associated with
chemotherapeutic regimens such as anthracyclines and trastuzumab
becomes a more significant issue. Assessment of the left ventricular
(LV) ejection fraction fails to detect subtle alterations in LV function.
The objective of this study was to evaluate whether more sensitive
echocardiographic measurements and biomarkers could predict future
cardiac dysfunction in chemotherapy-treated patients. Forty-three
patients diagnosed with breast cancer who received anthracyclines
and trastuzumab therapy underwent echocardiography and blood sampling
at 3 time points (baseline and 3 and 6 months during the course of
chemotherapy). The LV ejection fraction; peak systolic myocardial
longitudinal, radial, and circumferential strain; echocardiographic
markers of diastolic function; N-terminal pro-B-type natriuretic
peptide; and high-sensitivity cardiac troponin I were measured. Nine
patients (21%) developed cardiotoxicity (1 at 3 months and 8 at 6
months) as defined by the Cardiac Review and Evaluation Committee
reviewing trastuzumab. A decrease in longitudinal strain from baseline
to 3 months and detectable high-sensitivity cardiac troponin I at
3 months were independent predictors of the development of cardiotoxicity
at 6 months. The LV ejection fraction, parameters of diastolic function,
and N-terminal pro-B-type natriuretic peptide did not predict cardiotoxicity.
In conclusion, cardiac troponin plasma concentrations and longitudinal
strain predict the development of cardiotoxicity in patients treated
with anthracyclines and trastuzumab. The 2 parameters may be useful
to detect chemotherapy-treated patients who may benefit from alternative
therapies, potentially decreasing the incidence of cardiotoxicity
and its associated morbidity and mortality.