PDF(Pubmed)
Abstract：
Trastuzumab is widely used in HER2 breast cancer. However, it may cause left ventricular (LV) dysfunction. A decrease in LV global longitudinal strain (GLS) has been previously demonstrated to be a good predictor of subsequent cancer therapy related dysfunction (CTRCD). Left atrial morphological remodeling during Trastuzumab therapy has also been shown. The aim of this study is exploring the relationship between early changes in left atrial function and the development of Trastuzumab-induced cardiotoxicity. Consecutive patients with diagnosis of HER2+non-metastatic breast cancer treated with Trastuzumab were prospectively enrolled. A clinical, conventional, and advanced echocardiographic assessment was performed at baseline and every three months, until a one-year follow-up was reached. One-hundred-sixteen patients completed the 12 months follow-up, 10 (9%) cases of CTRCD were observed, all after the sixth month. GLS and LVEF significantly decreased in the CTRCD group at 6 months of follow-up, with an earlier (3 months) significant worsening in left atrial morpho-functional parameters. Systolic blood pressure, early peak atrial longitudinal strain (PALS), peak atrial contraction (PACS) and left atrial volume (LAVI) changes resulted independent predictors of CTRCD at multivariable logistic regression analysis. Moreover, early changes in PALS and PACS resulted good predictors of CTRCD development (AUC 0.85; p = 0.008, p < 0.001 and 0.77; p = 0.008, respectively). This prospective study emphasizes that the decline in PALS and PACS among trastuzumab-treated patients could possibly increase the accuracy in identifying future CTRCD in non-metastatic HER2 breast cancer cases, adding predictive value to conventional echocardiographic assessment.
摘要：
曲妥珠单抗广泛用于HER2乳腺癌。然而,它可能导致左心室（LV）功能障碍。先前已证明LV整体纵向应变（GLS）的降低是随后的癌症治疗相关功能障碍（CTRCD）的良好预测指标。曲妥珠单抗治疗期间的左心房形态重构也已显示。这项研究的目的是探索左心房功能的早期变化与曲妥珠单抗诱导的心脏毒性的发展之间的关系。前瞻性纳入连续诊断为曲妥珠单抗治疗的HER2+非转移性乳腺癌患者。临床，常规,在基线时和每三个月进行高级超声心动图评估，直到达到一年的随访。116名患者完成了12个月的随访，观察到10例（9％）CTRCD，都在第六个月之后。随访6个月时，CTRCD组GLS和LVEF显著下降，左心房形态功能参数较早（3个月）显着恶化。收缩压,早期峰值心房纵向应变（PALS），在多变量逻辑回归分析中,心房收缩峰值(PACS)和左心房容积(LAVI)变化是CTRCD的独立预测因子.此外，PALS和PACS的早期变化可很好地预测CTRCD的发展(AUC=0.85;p=0.008,p<0.001和0.77;p=0.008).这项前瞻性研究强调，曲妥珠单抗治疗的患者中PALS和PACS的下降可能会增加非转移性HER2乳腺癌患者未来CTRCD识别的准确性。为常规超声心动图评估增加预测值。
