CAN EXERCISE PREVENT CHEMOTHERAPY-INDUCED CARDIAC DYSFUNCTION? AN ECHOCARDIOGRAPHIC ASSESSMENT OF CARDIAC MECHANICS IN WOMEN WITH BREAST CANCER

Purpose The purpose of this analysis was to investigate trastuzumab-associated cardiac adverse effects in breast cancer patients after completion of (neo)adjuvant chemotherapy with or without radiotherapy. Patients and Methods The Herceptin Adjuvant (HERA) trial is a three-group, multicenter, open-label randomized trial that compared 1 or 2 years of trastuzumab given once every 3 weeks with observation in patients with HER-2–positive breast cancer. Only patients who after completion of (neo)adjuvant chemotherapy with or without radiotherapy had normal left ventricular ejection fraction (LVEF ≥ 55%) were eligible. A repeat LVEF assessment was performed in case of cardiac dysfunction. Results Data were available for 1,693 patients randomly assigned to 1 year trastuzumab and 1,693 patients randomly assigned to observation. The incidence of trastuzumab discontinuation due to cardiac disorders was low (4.3%). The incidence of cardiac end points was higher in the trastuzumab group compared with observation (severe congestive heart failure [CHF], 0.60% v 0.00%; symptomatic CHF, 2.15% v 0.12%; confirmed significant LVEF drops, 3.04% v 0.53%). Most patients with cardiac dysfunction recovered in fewer than 6 months. Patients with trastuzumab-associated cardiac dysfunction were treated with higher cumulative doses of doxorubicin (287 mg/m2 v 257 mg/m2) or epirubicin (480 mg/m2 v 422 mg/m2) and had a lower screening LVEF and a higher body mass index. Conclusion Given the clear benefit in disease-free survival, the low incidence of cardiac adverse events, and the suggestion that cardiac dysfunction might be reversible, adjuvant trastuzumab should be considered for treatment of breast cancer patients who fulfill the HERA trial eligibility criteria.

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Electrocardiographic Characteristics of Breast Cancer Patients Treated with Chemotherapy

Cardiology Research and Practice ◽

10.1155/2020/6678503 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Xufei Liang ◽

Yueying Wang ◽

Xi Yin ◽

Xiaohong Gong ◽

Shuo Pan ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Cardiac Dysfunction ◽

Area Under The Curve ◽

Qt Dispersion ◽

Drug Regimen ◽

P Wave ◽

Breast Cancer Patients ◽

P Wave Dispersion ◽

Cutoff Value

Introduction. Patients receiving chemotherapy for breast cancer may be at risk of developing cardiac dysfunction and electrophysiological abnormalities. The aim of this study is to evaluate alterations in electrocardiographic (ECG) parameters in breast cancer patients receiving chemotherapy. Materials and Methods. This was a prospective single-center cohort study conducted in the Fourth Hospital of Hebei Medical University, China. Participants with breast cancer referred for chemotherapy from May 1, 2019, to October 1, 2019, were invited to participate in the study. Standard 12-lead ECG and echocardiography were performed at baseline or before chemotherapy (prechemotherapy) (T0), after 1 cycle (T1), after 3 cycles (T2), and at the end of chemotherapy (T3). Results. A total of 64 patients with diagnosed breast cancer undergoing chemotherapy were included. Echocardiographic parameters showed no significant variation during the entire procedure (all P > 0.05 ). The incidence of abnormal ECG increased from 43.75% at baseline to 65.63% at the end of chemotherapy, of which only the prevalence of fragmented QRS (fQRS) was significantly increased after the drug regimen (26.56% to 53.13%). At the end of the treatment, heart rate, P-wave dispersion, corrected QT interval, T-peak to T-end, RR, SV1, RV5, Sokolow–Lyon index (SLI), and index of cardioelectrophysiological balance deteriorated markedly (all P < 0.05 ). The area under the curve for SLI and QT dispersion (QTd) derived by ECG was 0.710 and 0.606, respectively. The cutoff value with 2.12 of SLI by ECG had a sensitivity of 67.2% and specificity of 71.9% for differentiating patients after therapy from baselines. The cutoff value with 0.55 of QTd had a sensitivity of 60.9% and specificity of 60.9%. Conclusions. The current study demonstrated that ECGs can be used to detect electrophysiological abnormalities in breast cancer patients receiving chemotherapy. ECG changes can reflect subclinical cardiac dysfunction before the echocardiographic abnormalities.

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Abstract 13246: The Impact of Body-Mass Index Trajectories During Early Adulthood on Cardiac Mechanics in Middle Age: The CARDIA Study

Circulation ◽

10.1161/circ.130.suppl_2.13246 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Sadiya S Khan ◽

Sanjiv J Shah ◽

Kiang J Liu ◽

Cora E Lewis ◽

Christina Shay ◽

...

Keyword(s):

Body Mass Index ◽

Body Mass ◽

Young Adulthood ◽

Cardiac Dysfunction ◽

Middle Age ◽

Cardiac Mechanics ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

The Impact ◽

Baseline Bmi

Introduction: Obesity is a risk factor for left ventricular dysfunction and incident heart failure. We hypothesized that baseline body mass index (BMI) and trajectories in weight change through young adulthood are associated with abnormal cardiac mechanics in middle age. Methods: We examined 2,735 participants from the Coronary Artery Risk Development in Young Adults (CARDIA) study. BMI was calculated at exam years 0, 2, 5, 7, 10, 15, 20, 25. 2D echo was performed with speckle-tracking analysis. Left ventricular ejection fraction (LVEF) and global longitudinal, circumferential, and radial strain (GLS, GCS, GRS, respectively) were measured at y25. Group-based modeling with latent class analysis (PROC TRAJ) was used to identify trajectories in relative changes in BMI (% change in BMI from baseline at each exam). Linear regression examined associations between baseline BMI and trajectory of BMI change and absolute GLS, GCS, and GRS at y25 adjusting for demographics, risk factors, and echo parameters. Results: Mean age at baseline was 25±4 years. Baseline BMI at y0 was significantly associated with mean GLS at y25 (p=0.01), but not GRS or GCS. We identified 4 distinct trajectories of relative BMI change: stable weight (36% of sample), mild increase (40%), moderate increase (18%), and major increase (6%) in weight (Figure). At y25, there was no difference in LVEF across the 4 BMI trajectory groups (P=NS). After adjustment for clinical variables and baseline BMI, absolute GLS was lower in groups with BMI increases (overall P<0.001). GRS and GCS were not significantly different between the groups. Conclusion: In conclusion, baseline BMI and increases in BMI during young adulthood are significantly associated with the presence of subclinical cardiac dysfunction in middle age despite normal EF. This novel characterization of BMI trajectories across young adulthood may assist in improving understanding of the impact of weight gain and obesity on cardiac dysfunction.

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Abstract PS3-21: Predicting cardiac dysfunction in breast cancer patients undergoing aromatase inhibitor treatment using biomechanical model-based elasticity imaging

10.1158/1538-7445.sabcs20-ps3-21 ◽

2021 ◽

Author(s):

Caroline Elizabeth Miller ◽

Jennifer Jordan ◽

Alexandra Thomas ◽

Jared Weis

Keyword(s):

Breast Cancer ◽

Aromatase Inhibitor ◽

Cancer Patients ◽

Cardiac Dysfunction ◽

Biomechanical Model ◽

Elasticity Imaging ◽

Breast Cancer Patients ◽

Model Based ◽

Aromatase Inhibitor Treatment ◽

Inhibitor Treatment

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Prevention of cardiac dysfunction during adjuvant breast cancer therapy (PRADA): a 2 × 2 factorial, randomized, placebo-controlled, double-blind clinical trial of candesartan and metoprolol

European Heart Journal ◽

10.1093/eurheartj/ehw022 ◽

2016 ◽

Vol 37 (21) ◽

pp. 1671-1680 ◽

Cited By ~ 274

Author(s):

Geeta Gulati ◽

Siri Lagethon Heck ◽

Anne Hansen Ree ◽

Pavel Hoffmann ◽

Jeanette Schulz-Menger ◽

...

Keyword(s):

Breast Cancer ◽

Clinical Trial ◽

Cancer Therapy ◽

Cardiac Dysfunction ◽

Breast Cancer Therapy ◽

Double Blind ◽

Double Blind Clinical Trial ◽

Adjuvant Breast Cancer

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Trastuzumab-Related Cardiac Dysfunction

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2011.0019 ◽

2011 ◽

Vol 9 (2) ◽

pp. 243-249 ◽

Cited By ~ 20

Author(s):

Melinda L. Telli ◽

Ronald M. Witteles

Keyword(s):

Breast Cancer ◽

Heart Failure ◽

Cardiac Dysfunction ◽

Cardiac Troponin ◽

Troponin I ◽

Safety Data ◽

Cardiac Safety ◽

Ongoing Controversy ◽

Mechanistic Insight

The use of trastuzumab in the adjuvant and metastatic treatment of breast cancer is associated with both symptomatic and asymptomatic cardiotoxicity. The long-term significance of these events, isolating known cardiotoxic effects of anthracyclines from those of trastuzumab, and the appropriateness of referring to trastuzumab-related cardiotoxicity as reversible rather than responsive to trastuzumab withdrawal and heart failure medical therapy, are issues that continue to be debated. This article provides an overview of the available cardiac safety data from the major trastuzumab clinical trials in breast cancer, highlighting areas of ongoing controversy. Important recent data documenting the occurrence and prognostic use of cardiac troponin I elevations among patients treated with trastuzumab are placed into context with the mechanistic insight these data provide and the implications for clinical practice today.

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