Early Echocardiography and ECG Changes Following Radiotherapy in Patients with Stage II-III HER2-Positive Breast Cancer Treated with Anthracycline-Based Chemotherapy with or without Trastuzumab-Based Therapy

Figures

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  Figure 1. (A) Three-dimensional reconstruction of the main arteries of the coronary vascular system: the left coronary artery (LCA), the right coronary artery (RCA), the left anterior descending artery (LAD), and the anterior circumflex artery (ACX). (B) Anatomical relationships of the coronary vasculature to the left ventricle walls (LV). (C) Three-dimensional reconstruction of the emergence of the coronary vasculature from the ascending aorta (AA). (D) Three-dimensional reconstruction of the walls of the 2 left (LV) and right (RV) ventricles together with the most voluminous vascular pathways – ascending aorta (AA) and pulmonary trunk (PT) – and coronary vasculature. Reconstruction was performed in Varian Eclipse version 10 (2012).

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  Figure 2. Association of cardiac preconditioning, electrocardiographic semiology, and dosimetry with a drop in ejection fraction (EF) after radiotherapy end and before anti-HER2 therapy start. The 95% confidence intervals are plotted in a logarithmic scale for OR (from 1 to 1000) and RR (from 1 to 100).

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  Figure 3. Independent predictors (univariate models) of the downward evolution of EF after CHT administration: the evolution of echo- and electrocardiographic semiology, the doses of CHT and RT, and with the cardiac preconditioning at the beginning of the treatment. The 95% confidence intervals are plotted in a logarithmic scale (from 1 to 1000) for OR and (from 1 to 10) for RR.

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  Figure 4. The association of a more than 10% total drop in ejection fraction during echocardiographic monitoring with the administration of multimodal treatment and with the pre-existence of electrocardiographic modifications at the initial control to establish the baseline. The 95% confidence intervals are plotted in a logarithmic scale (from 1 to 1000) for OR and (from 1 to 10) for RR. TT is targeted therapy, ie, anti-HER2 therapy.

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  Figure 5. Associations of classes of cardiac conditions with the EF drop pattern and value ≥10%. The 95% confidence intervals are plotted in a logarithmic scale for OR (from 1 to 1000) and RR (from 1 to 10).

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  Figure 6. The association of changes in echocardiographic semiology with the decrease in EF ≥10% (as a predictor) during monitoring, with treatment modalities, and with the pre-existence of some comorbidities (cardiac preconditioning). The 95% confidence intervals are plotted in a logarithmic scale (from 1 to 1000) for OR and (from 1 to 10) for RR. TT is targeted therapy, ie, anti-HER2 therapy.