Evaluating Cardiotoxicity in Breast Cancer Patients Treated with HER2 Inhibitors: Could a Combination of Radionuclide Ventriculography and Cardiac Biomarkers Predict the Cardiac Impact?

Figures

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  Figure 1. Flow diagram illustrating the patient-selection process. Abbreviations: RNV—radionuclide ventriculography.

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  Figure 2. Patient presenting a small decrease in LVEF, not fulfilling the ESC criteria for cardiotoxicity. This 55-year-old female patient suffered from HER2 2+ invasive lobular carcinoma (confirmed through FISH), ER- and PR-negative, previously treated with taxanes. During the 6-month period, she received eight cycles of trastuzumab, pertuzumab and docetaxel. A small decline in LVEF can be observed in both planar and SPECT images, with the EF diminishing from 61% at T0 (a) to 56% at T1 (b) on the planar scans, and from 64% (T0—(c)) to 59% (T1—(d)) on the SPECT acquisitions.

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  Figure 3. Patient fulfilling the ESC criteria for cardiotoxicity. This 64-year-old female patient suffered from HER2 3+ invasive ductal carcinoma, ER- and PR-negative, previously treated with anthracyclines. During the 6-month period, she received six cycles of trastuzumab, pertuzumab and docetaxel. A decline in LVEF can be observed in both planar and SPECT images, with the EF diminishing from 54% at T0 (a) to 44% at T1 (b) on planar scans, and from 58% (T0—(c)) to 48% (T1—(d)) on the SPECT acquisitions.

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  Figure 4. Correlation between NT-proBNP and LVEFs at T0 (a) and T1 (b). Abbreviations: NT-proBNP—amino-terminal fragment of the prohormone brain-type natriuretic peptide; LVEF—left ventricular ejection fraction; T0—baseline scan; T1—follow-up scan.