Key result
Anti-HER2 therapy is linked to early cardiotoxicity in ~26% of low-to-moderate risk patients.
Why the study?
Cardiotoxicity in low-to-moderate cardiovascular risk patients undergoing anti-HER2 therapy was not well characterized using cardiac magnetic resonance imaging.
Does anti-HER2 therapy cause early changes in cardiac magnetic resonance parameters and cardiotoxicity in breast cancer patients with low-to-moderate cardiovascular risk?
Cohort (n=35)
Single-blind (radiologist blinded to clinical data)
No
Does anti-HER2 therapy cause early changes in cardiac magnetic resonance parameters and cardiotoxicity in breast cancer patients with low-to-moderate cardiovascular risk?
Even in low-to-moderate risk patients, anti-HER2 therapy induces early and detectable subclinical cardiotoxicity and myocardial tissue changes on CMR, highlighting the need for continued surveillance.
Answers are grounded in this paper and cite their sources.
Supports cardiotoxicity monitoring beyond high-risk groups; leaves open CMR T1 mapping utility for early detection.
BACKGROUND: The study aimed to investigate cardiotoxicity among individuals undergoing anti-human epidermal growth factor receptor 2 (HER2) therapy with a low-to-moderate risk of cardiovascular complications. Cardiac magnetic resonance (CMR) imaging was employed in the investigation. PATIENTS AND METHODS: HER2-positive breast cancer patients who underwent CMR examinations both before and during therapy (first follow-up: 3-5 months; second follow-up: 6-12 months) between January 2021 and December 2022 were prospectively included. Each patient was evaluated for the risk of cardiovascular toxicity. RESULTS: Thirty-five HER2-positive breast cancer patients were included (48.86 ± 10.34 years). Eighty-nine percent of patients had low cardiovascular toxicity risk, and 11% had moderate cardiovascular toxicity risk. At follow-up CMR, nine (25.71%) patients developed cardiac dysfunction. At follow-up 1, there was a notable decrease in left ventricular ejection fraction, stroke volume index, cardiac output index, and absolute strain values, accompanied by higher T1 and T2 values as well as end-systolic volume index compared to baseline (p ≤ 0.002). At follow-up 2, the T1 and T2 values recovered to near baseline. The cardiac output index exhibited a continuous decline (p ≤ 0.022), while other variables were similar (p > 0.05). Furthermore, at follow-up 1, the T1 value displayed a marked increase in patients with 1-3 points in cardiovascular toxicity risk factors compared to those with no risk factors (p ≤ 0.043). CONCLUSIONS: It is common for patients with low-to-moderate cardiovascular risk to experience early cardiotoxicity during anti-HER2 therapy. T1 mapping was a valuable approach for quantifying the specific extent of subtle tissue damage.
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Cheng et al. (2025) conducted a cohort in HER2-positive breast cancer (n=35). Anti-HER2 therapy vs. Baseline (pre-treatment) was evaluated on Left ventricular ejection fraction (LVEF) at 3-5 months follow-up (p=<0.001). Anti-HER2 therapy was associated with early cardiotoxicity in 25.71% of low-to-moderate risk patients, characterized by a significant reduction in left ventricular ejection fraction from 64.03% to 57.34% (p<0.001).
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