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Anthracyclines and trastuzumab, used for therapy in breast cancer overexpressing Human Epidermal Growth Factor 2 (HER2), have a cardiotoxicity as a major adverse effect that could be followed by symptomatic heart failure. We prospectively investigated whether blood biomarkers and echocardiographic parameters predicted incident cardiotoxicity in breast cancer patients treated with these drugs.
Sixteen women with HER2 positive breast cancer treated with anthracyclines followed by trastuzumab were enrolled. Blood samples and echocardiographic parameters were evaluated at baseline and every 3 months up to 1 year during trastuzumab therapy.
Any patients did not develop symptomatic heart failure. Seven patients (44%, group R) showed a reduction of LVEF ≥5% at 12 months. Another nine patients (56%, Group N) showed a reduction of LVEF <5%. High sensitive troponin T (hsTnT) at 6 months in group R was significantly higher than that in group N (12.1±8.9 pg/mL vs. 3.3±0.7 pg/mL, p<0.05). A cutoff value of 5.5 pg/ml of hsTnT predicted reduction of LVEF with a sensitivity of 85.7%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 90%. Peak early diastolic velocity of septal mitral annulus (e') at baseline was significantly lower in group R than in group N (6.8±0.9 cm/s vs. 11.1±3.6 cm/s, p<0.05). A cutoff value of 8.0 cm/s of e’ predicted reduction of LVEF with a sensitivity of 100%, specificity of 71.4%, positive predictive value of 75%, and negative predictive value of 100%.
In breast cancer patients treated with anthracyclines and trastuzumab, hsTnT and e’ are useful to predict reduction of LVEF and have a possibility as guides to avoid cardiac adverse effects.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Dilated Cardiomyopathies: From Peripartum, Cancer Therapy, Familial Cardiomyopathies to Cardiac Amyloidosis
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1134-279
- 2013 American College of Cardiology Foundation