MethodsTemporal Variability of Global Longitudinal Strain in Stable Patients Undergoing Chemotherapy With Trastuzumab
Section snippets
Methods
This is a retrospective analysis of data from 30 consecutive female patients with a history of breast cancer who underwent chemotherapy with trastuzumab and echocardiography in our laboratory from June 2011 to December 2015. Patients were included if they satisfied the following criteria: (1) at least 3 sequential echocardiograms, including a baseline echocardiogram before treatment with each performed at 3-month intervals; (2) all echocardiography studies performed with Vivid 7 or E9 (GE
Results
Thirty women receiving trastuzumab were included with a mean age of 57.1 ± 11.3 years. Medications initiated before chemotherapy included β blockers (carvedilol or metoprolol) in 11 patients; angiotensin-converting enzyme inhibitors (lisinopril and ramipril) in 5 patients and statins in 4 patients (Table 1). None of the patients received insulin or antiplatelet medications including aspirin and clopidogrel (Bristol-Myers Squibb, Bridgewater, New Jersey). There were no changes of medications in
Discussion
Chemotherapy with HER2 antibodies for breast cancer has been documented to cause LV dysfunction. A reduction in GLS may represent one of the earliest signs of cardiotoxicity and may provide incremental value in identifying patients who would experience subsequent systolic dysfunction.6, 7, 8, 9, 10, 11 In a consensus document by the American Society of Echocardiography and European Association of Cardiovascular Imaging, subclinical LV dysfunction is defined as a relative reduction in GLS by
Disclosures
The authors have no conflicts of interest to disclose.
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Cited by (6)
A Test in Context: Myocardial Strain Measured by Speckle-Tracking Echocardiography
2017, Journal of the American College of CardiologyCitation Excerpt :Of note, quoted variability for EF and GLS has generally been derived from studies performed in healthy volunteers under controlled conditions within academic centers between 2 time points only. The actual real-world clinical variability for such parameters in sick patients undergoing chemotherapy, with testing often performed multiple times (>2 studies) has the potential to overlap cutoffs defining toxicity (50,52). Thus, rather than relying on interpretation of interval changes of a single parameter in an isolated fashion, it may be advantageous to have concomitant strain assessment, in addition to EF, to provide additional supportive data with regard to suspected cardiotoxicity (53).
Cardiac surveillance for anti-HER2 chemotherapy
2021, Cleveland Clinic Journal of MedicineRegional variability in longitudinal strain across vendors in patients with cardiomyopathy due to increased left ventricular wall thickness
2019, Circulation: Cardiovascular ImagingTest–retest reliability of new and conventional echocardiographic parameters of left ventricular systolic function
2019, Clinical Research in CardiologyPersonalized assessment of the coronary atherosclerotic arteries by intravascular ultrasound imaging: Hunting the vulnerable plaque
2019, Journal of Personalized Medicine
Drs. Koneru and Collier equally contributed to this study.
Dr. Tamarappoo was supported by the American Heart Association Clinical Research Program: 11CRP5050015 and the NIH CTSA KL2 grant: 2KL2TR000440.
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