Key result
Trastuzumab therapy in breast cancer patients was associated with a significant reduction in right ventricular global longitudinal strain from -23.9% at baseline to -22.5% at 3 months.
Why the study?
Cardiotoxicity is the primary adverse effect of trastuzumab use, but the role of the right ventricle in this setting remains unclear.
Observational (n=25)
Echocardiographer blinded to clinical data
No
Trastuzumab therapy is associated with early subclinical reductions in right ventricular function (RV GLS and RV FAC), though these changes do not appear to correlate with the development of subclinical left ventricular cardiotoxicity.
RV changes during trastuzumab may warrant monitoring; leaves open whether RV assessment improves CDT detection or outcomes.
PurposeCardiotoxicity (CDT) is the main adverse effect related to trastuzumab (TTZ) use, and the role of the right ventricle (RV) in this context is not clear. We aimed to evaluate the longitudinal changes in RV function during TTZ therapy and to determine the differences in RV function associated with subclinical CDT.MethodsPatients with breast cancer underwent echocardiograms at the beginning of TTZ treatment (Ex 1) and every 3 months during the first year (Ex 2, 3, 4). Subclinical CDT was defined as ≥ 12% relative reduction of left ventricle global longitudinal strain (LV GLS).ResultsTwenty-five women (52.1 ± 13.1 y-o) were included. We found a decrease in LV ejection fraction between the first and fourth exams and the LV GLS gradually decreased during follow-up (Ex1: -20.6 ± 2.0; Ex2: -19.4 ± 2.1; Ex3: -19.2 ± 1.8; Ex4: -19.0 ± 2.1, all p < 0.05). RV GLS changed from baseline to 3 month and to 6 month (Ex1: -23.9% ± 1.6; Ex2: -22.5% ± 2.1; Ex3: -22.5% ± 2.3, all p < 0.05), and the RV Fractional Area Change was lower in the third exam (Ex1: 44.3% ± 6.6 vs Ex3: 39.9% ± 6.0, p = 0.004). We found subclinical CDT in 13 patients (52%); changes in RV parameters had the same pattern of changing in the group with and without subclinical CDT.ConclusionIn this sample, the RV function decreased during TTZ therapy and the decrease was not associated to the observed LV cardiotoxicity.
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Mazzutti et al. (2021) conducted an observational in Early HER2-positive breast cancer (n=25). Trastuzumab vs. Baseline was evaluated on Right ventricular global longitudinal strain (RV GLS) at 3 months (p=0.02). Trastuzumab therapy in breast cancer patients was associated with a significant reduction in right ventricular global longitudinal strain from -23.9% at baseline to -22.5% at 3 months.
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