Assessment of Echocardiography and Biomarkers for the Extended Prediction of Cardiotoxicity in Patients Treated With Anthracyclines, Taxanes, and Trastuzumab

By Heloisa Sawaya, I. Sebag, J. Plana, J. Januzzi, B. Ky, T. Tan, V. Cohen, J. Banchs, J. Carver, S. Wiegers and 7 more. Circulation Cardiovascular Imaging, 2012

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Background—Because cancer patients survive longer, the impact of cardiotoxicity associated with the use of cancer treatments escalates. The present study investigates whether early alterations of myocardial strain and blood biomarkers predict incident cardiotoxicity in patients with breast cancer during treatment with anthracyclines, taxanes, and trastuzumab. Methods and Results—Eighty-one women with newly diagnosed human epidermal growth factor receptor 2–positive breast cancer, treated with anthracyclines followed by taxanes and trastuzumab were enrolled to be evaluated every 3 months during their cancer therapy (total of 15 months) using echocardiograms and blood samples. Left ventricular ejection fraction, peak systolic longitudinal, radial, and circumferential myocardial strain were calculated. Ultrasensitive troponin I, N-terminal pro–B-type natriuretic peptide, and the interleukin family member (ST2) were also measured. Left ventricular ejection fraction decreased (64 ± 5% to 59 ± 6%; P<0.0001) over 15 months. Twenty-six patients (32%, [22%–43%]) developed cardiotoxicity as defined by the Cardiac Review and Evaluation Committee Reviewing Trastuzumab; of these patients, 5 (6%, [2%–14%]) had symptoms of heart failure. Peak systolic longitudinal myocardial strain and ultrasensitive troponin I measured at the completion of anthracyclines treatment predicted the subsequent development of cardiotoxicity; no significant associations were observed for left ventricular ejection fraction, N-terminal pro–B-type natriuretic peptide, and ST2. Longitudinal strain was <19% in all patients who later developed heart failure. Conclusions—In patients with breast cancer treated with anthracyclines, taxanes, and trastuzumab, systolic longitudinal myocardial strain and ultrasensitive troponin I measured at the completion of anthracyclines therapy are useful in the prediction of subsequent cardiotoxicity and may help guide treatment to avoid cardiac side-effects.

Subfields: Cardiology and Cardiovascular Medicine, Oncology

View Paper: https://www.semanticscholar.org/paper/cbd402ac097f23552373e4dbc9667e7a1a7a3267

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In Cardiology and Cardiovascular Medicine

In Oncology

J. Herrmann

Citations in the corpus

Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy: a systematic review. (2014, background): “7% (38,40,41) may also indicate early myocardial changes, these changes have been less consistent (30,34,41,42).”
2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). (2016, background): “Several recent studies have shown the value of deformation imaging for early detection of LV dysfunction secondary to cancer therapy.92 Global systolic longitudinal myocardial strain (GLS) has been reported to accurately predict a subsequent decrease in LVEF.101,102 A relative percentage reduction o”
Cardiotoxicity of anticancer treatments: Epidemiology, detection, and management (2016, background): “However, this result was associated with a reduction in sensitivity to 35%.(126)”
Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations (2020, background): “There are a small number of studies to suggest that angiotensin-converting enzyme inhibitors (ACE-Is), angiotensin receptor blockers (ARBs) or selected beta blockers (BBs) such as carvedilol and nebivolol may be the preferred agents to reduce the risk of cardiotoxicity (Table 2).65,66 In a single-ce”
2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines (2016, background): “Several recent studies have shown the value of deformation imaging for early detection of LV dysfunction secondary to cancer therapy.92 Global systolic longitudinal myocardial strain (GLS) has been reported to accurately predict a subsequent decrease in LVEF.101,102 A relative percentage reduction o”
Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. (2014, methodology): “Sawaya et al.160 published findings in the anthracycline and trastuzumab breast cancer population, suggesting that the assessmentof ultrasensitive troponin levels at the same time asSTE-derived strain imaging obtained after anthracycline exposure has improved specificity of 93%, in comparison with e”