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Echocardiography signs of early cardiac impairment in patients with breast cancer and trastuzumab therapy

Clinical Research in Cardiology volume 101, pages 415–426 (2012)Cite this article

Abstract

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.

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Acknowledgments

We would like to thank Professor Katharina Pachmann for reviewing the manuscript.

Conflict of interest

None declared.

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Affiliations

  1. Medizinische Klinik I, Kardiologie und Angiologie, Klinikum Worms, Akademisches Lehrkrankenhaus der Johannes–Gutenberg–Universität, Mainz, Germany

    Stefan A. Lange, Astrid Wess & Jens Jung

  2. Herzzentrum Dresden, Universitätsklinikum Carl-Gustav-Carus an der Technischen Universität, Dresden, Germany

    Bernd Ebner

  3. Frauenklinik, Brustzentrum-Perinatalzentrum, Klinikum Worms, Akademisches Lehrkrankenhaus der Johannes–Gutenberg–Universität, Mainz, Germany

    Matthias Kögel & Thomas Hitschold

  4. Institut für Pathologie, Universitätsklinikum Jena, Jena, Germany

    Mieczyslaw Gajda

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  1. Stefan A. Lange
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Correspondence to Stefan A. Lange.

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S. A. Lange and B. Ebner contributed equally to this work.

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Lange, S.A., Ebner, B., Wess, A. et al. Echocardiography signs of early cardiac impairment in patients with breast cancer and trastuzumab therapy. Clin Res Cardiol 101, 415–426 (2012). https://doi.org/10.1007/s00392-011-0406-0

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Keywords

  • Trastuzumab therapy
  • Cardiomyopathy
  • Mitral valve insufficiency
  • Echocardiography