Author + information
- Carolina M.P.D. Carvalho Silva,
- Marcio Bittencourt,
- Marilia Santos,
- Cristina Bittar,
- Silvia Fonseca,
- Giovanni Pinto,
- Isabela Costa,
- Clara Figueiredo,
- Julio Siqueira,
- Marina Bond,
- Paulo Neto,
- Thalita Gonzalez,
- Laura Testa,
- Paulo Hoff,
- Roberto Kalil-Filho and
- Ludhmila Hajjar
Although serial echocardiography (ECHO) is recommended every three months during treatment with trastuzumab for cardiotoxicity screening, this recommendation is based on expert opinion. We sought to investigate the incidence of Trastuzumab cardiotoxicity in real-world patients, its potential impact in clinical outcomes, and we tried to identify factors associated with worse outcomes
We included patients that received Trastuzumab for breast cancer treatment in whom a baseline and follow up ECHOs were performed during the first six months of Trastuzumab treatment. Patients had an ECHO schedule at the discretion of the oncologist. Patients with baseline ventricular dysfuncion or those who developed symptoms of cardiotoxicity prior to the routine ECHO follow up were excluded. We evaluated the prevalence of asymptomatic left ventricular (LV) dysfunction (defined as a 10 percent ejection fraction drop below 55%) and searched for its related predictors.
We included 806 patients (age 53±12, 53% left breast cancer, 84% in an adjuvant or neoadjuvant regimen). Main comorbidities were hypertension (37.4%), dyslipidemia (16.5%), diabetes (14.4%), tobacco use (13.4%), coronary artery disease (1.1%). Previous use of Doxorubicin occured in 75.3% of patients (fixed dose of 240mg/m2) and radiation therapy in 64% (mean dose 49Gy±8.7). Mean number of Trastuzumab cycles were 13. Patients had ECHOs schedules at the discretion of the oncologist. Of 806 patients, 610 had a 12 week-ECHO and 657 a 24 week-ECHO. Mean ejection fraction at baseline, at 12-weeks and at 24-weeks were, respectively: 64.72 (±4.65), 63,2 (±5.55) and 62,65 (±6.09). Mean systolic and diastolic LV diameters remained normal at these time points. 54 patients (6.7%) developed cardiotoxicity; of these, 73% were able to continue Trastuzumab treatment with heart failure medications. No clinical factors were associated with the development of LV dysfunction in a multivariable analysis.
The incidence of Trastuzumab cardiotoxicity in real-world is low, and the yield of routine ECHOs for screening of asymptomatic LV dysfunction is also low.
Moderated Poster Contributions
Heart Failure and Cardiomyopathies Moderated Poster Theater, Poster Hall, Hall F
Sunday, March 17, 2019, 10:15 a.m.-10:25 a.m.
Session Title: Cardio-Oncology Biomarkers and Imaging Measures in Clinical Practice
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1021-07
- 2019 American College of Cardiology Foundation