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Early diastolic strain rate measurements by cardiac MRI in breast cancer patients treated with trastuzumab: a longitudinal study

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Abstract

We evaluated temporal changes in early diastolic strain rates by cardiovascular magnetic resonance (CMR) as an early detector of trastuzumab-induced ventricular dysfunction. We conducted a prospective, multi-centre, longitudinal observational study of 41 trastuzumab-treated breast cancer women who underwent serial CMR (baseline, 6, 12, and 18 months). Two blinded readers independently measured left ventricular ejection fraction (LVEF), peak systolic strain parameters (global longitudinal strain [GLS] and global circumferential strain [GCS]), and early diastolic strain rate parameters (global longitudinal diastolic strain rate [GLSR-E], global circumferential diastolic strain rate [GCSR-E], and global radial diastolic strain rate [GRSR-E]), by feature tracking (FT-CMR) using CMR42. There was a significant decline in peak systolic strain GLS and GCS at 6 months (p = 0.024 and p < 0.001, respectively) and 12 months (p = 0.002 and p < 0.001, respectively), followed by recovery at 18 months, which paralleled decline in LVEF at 6 months (p = 0.034) and 12 months (p = 0.012). Conversely, early diastolic strain rates GLSR-E and GCSR-E did not significantly change over 18 months (p > 0.10), while GRSR-E was marginally significant at 12 months (p = 0.021). There was no significant correlation between changes at 6 months in LVEF and GLSR-E or GRSR-E (p > 0.10), and a marginally significant weak correlation between LVEF and GCSR-E (p = 0.046). Among trastuzumab-treated patients without overt cardiotoxicity, there was no consistent temporal change in FT-CMR-derived diastolic strain rate parameters up to 18 months, in contrast to decline in systolic strain and LVEF. Systolic strains by FT-CMR are likely more useful than diastolic strain rates for monitoring subclinical trastuzumab-related myocardial dysfunction.

ClinicalTrials.gov identifier NCT01022086.

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Acknowledgements

This study was funded by an operating grant from the Canadian Institutes of Health Research (CIHR) and Roche. We thank all the patients who participated in this study, the study coordinators, and Rosane Nisenbaum for her assistance in data management. Dr Kim A. Connelly is supported by a New Investigator award from the CIHR and an Early Researcher award from the Ministry of Ontario. Dr. Yan is supported by a Clinician-Scientist Award from the University of Toronto. Dr. Thavendiranathan is supported by a New Investigator Award from the CIHR.

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Authors and Affiliations

  1. University of Toronto, Toronto, Canada

    Inna Y. Gong, Christine Brezden-Masley, Djeven P. Deva, Kelvin K. W. Chan, John J. Graham, Chi-Ming Chow, Paaladinesh Thavendiranathan, Day Dai, Joseph J. Barfett, Kim A. Connelly & Andrew T. Yan

  2. Terrence Donnelly Heart Centre, Division of Cardiology, St. Michael’s Hospital, Toronto, Canada

    Geraldine Ong, John J. Graham, Chi-Ming Chow, Joseph J. Barfett, Kim A. Connelly & Andrew T. Yan

  3. Division of Hematology/Oncology, St Michael’s Hospital, Toronto, Canada

    Christine Brezden-Masley & Vinita Dhir

  4. Department of Medical Imaging, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada

    Djeven P. Deva

  5. Sunnybrook Odette Cancer Centre, Canadian Center for Applied Research in Cancer Control, Toronto, Canada

    Kelvin K. W. Chan

  6. Toronto General Hospital, University Health Network, Toronto, Canada

    Paaladinesh Thavendiranathan

  7. The University of Hong Kong, Hong Kong, China

    Ming-Yen Ng

  8. Division of Cardiology, St. Michael’s Hospital, 30 Bond Street, Rm 6-030 Donnelly, Toronto, M5B 1W8, Canada

    Andrew T. Yan

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  1. Inna Y. Gong
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Correspondence to Andrew T. Yan.

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C. Brezden-Masley has received research grant support and/or honoraria for educational activities and/or served as consultant to Roche.

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Gong, I.Y., Ong, G., Brezden-Masley, C. et al. Early diastolic strain rate measurements by cardiac MRI in breast cancer patients treated with trastuzumab: a longitudinal study. Int J Cardiovasc Imaging 35, 653–662 (2019). https://doi.org/10.1007/s10554-018-1482-2

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  • DOI: https://doi.org/10.1007/s10554-018-1482-2

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