Herceptin-Mediated Cardiotoxicity: Assessment by Cardiovascular Magnetic Resonance

Figure 1. Representative images of trastuzumab-induced cardiotoxicity. Cine 3-chamber (a) and 4-chamber views (b) as well as short axis view (c) during baseline study (LVEF = 66%) and 3 months thereafter (LVEF = 54%). Native T1 (d) shows reduction of global left ventricular value after 3 days (baseline = 1196 ms, 1st follow-up = 1172 ms, and 2nd follow-up = 1277 ms). Myocardial T2 (f) shows subtle elevation of global value after 3 months (baseline = 40 ms, 1st follow-up = 43 ms, and 2nd follow-up = 44 ms). The average segmental T1 and T2 times are displayed as “bull's eye” images (e, g). The colour maps represent continuous T1 and T2 values. LVEF, left ventricular ejection fraction; reproduced with permission from Abdelmonem Atia et al. [22].

Figure 2. Mean bias associated with LV quantification by multimodality imaging compared to reference CMR using data derived from Rigolli et al. [45].

Figure 3. Short axis reconstructed IR-TrueFISP image through the mid-ventricle demonstrates subepicardial linear delayed enhancement (arrow) in the lateral wall of a patient who had received trastuzumab [69]; reprinted with permission from Wadhwa et al. [82].

Figure 4. Proposed 30-minute cardiac magnetic resonance imaging protocol for the assessment of trastuzumab cardiotoxicity. LV, left ventricle; MOLLI, modified look-locker inversion recovery; ShMOLLI, shortened modified look-locker inversion recovery; STIR, short tau inversion recovery; IR, inversion recovery; PSIR, phase-sensitive inversion recovery.