Trastuzumab-related cardiotoxicity in patients with non-limiting cardiac comorbidity.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e12043-e12043
Author(s):  
Rossella Martinello ◽  
Paolo Becco ◽  
Patrizia Vici ◽  
Mario Airoldi ◽  
Lucia Del Mastro ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Breast Cancer Patients ◽  
Adjuvant Trastuzumab ◽  
Ventricular Ejection Fraction ◽  
Cardiac Comorbidity

e12043 Background: Significant and symptomatic cardiac comorbidity (CC) is a contraindication to adjuvant trastuzumab (T) in breast cancer patients (pts). However, some pts with asymptomatic, non-limiting CC and normal baseline left ventricular ejection fraction (LVEF) receive T in the clinical practice. We sought to describe the tolerability of T in these pts. Methods: Retrospective analysis of pts with baseline asymptomatic non-limiting CC receiving adjuvant T with chemotherapy (CT) at 6 Institutions between Jul 2006 and Jan 2016. Results: Thirty-seven patients HER2-positive, operable BC at high risk of relapse BC were studied. Median age was 64y (range 36-82, 80% post-menopausal), median baseline LVEF was 61% (range 50-85%) and median BMI 26 (18-42, obesity 22%). Thirteen patients (35%) received T with adjuvant anthracycline and taxane-based, 19 (51%) taxane-based and 3 (8%) other adjuvant CT regimens (13 pts sequential, 22 pts concomitant with CT) and 2 (5%) with endocrine therapy. Prior non-limiting CC was ischemic heart disease (35%), valvular disease (30%), atrial fibrillation (19%), conduction disorders (13%), aortic aneurism (3%), and other (19%). Nine (29%) pts experienced TRC: congestive heart failure (1 pt, 3%), LVEF reduction (6 pts, 16%) and rhythm disturbances (1 pt, 3%). TRC occurred in pts with ongoing multiple cardiovascular risk factors (i.e. obesity and hypertension). Seven pts discontinued T because of TRC (19%), 5 permanently (14%) and 2 temporarily (5%). These latter pts, were able to resume and complete T after TRC resolution. At the end of adjuvant treatment, all pts showed LVEF within normal limits, except one of those who experienced a TRC (last FU value 46 %). Conclusions: This is the first analysis of TRC in pts receiving adjuvant T in the presence prior non-limiting CC. Despite the small size, our analysis shows that T is feasible in these pts and most of the TRC events were reversible at T withdrawal. Caution is needed in pts with significant ongoing cardiovascular risk factors, but when adjuvant T is deemed beneficial on breast cancer outcomes, non-limiting CC should not preclude treatment.

Cardiotoxicity risks of adjuvant trastuzumab in Asian breast cancer patients

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 561-561
Author(s):  
V. Shih ◽  
A. Chan ◽  
J. Chiang ◽  
C. Teo ◽  
J. Chen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cancer Patients ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Breast Cancer Patients ◽  
Chi Square ◽  
Adjuvant Trastuzumab ◽  
Ventricular Ejection Fraction ◽  
Chi Square Test

561 Background: Adjuvant trastuzumab (T)-based chemotherapy has been shown to reduce relapse and improve survival in breast cancer patients but has been associated with increased risks of cardiotoxicity. Our study aims to define the incidence and severity of cardiotoxicity amongst Asian breast cancer patients. Methods: This is a retrospective review of patients who have received adjuvant T from June 2005 to 2007. Cardiotoxicity was defined as a drop in left ventricular ejection fraction (LVEF) to less than 50% and/or reduction of > 10% of baseline. Cardiovascular (CVS) risk factors were defined as having a family history or presence of CAD, hypertension, diabetes mellitus, hyperlipidemia and smoking. We used pair sampled t-test to evaluate the mean LVEF change and Chi-square test to evaluate the association of cardiotoxicity and demographics. Results: There were 179 female patients. Cardiotoxicity was reported in 70 (39.1%), of whom 59 had asymptomatic decline in LVEF and 11 experienced CHF. Mean LVEF, comparing various time points (3, 6, 9 and 12 months) against baseline showed statistically significant decline (p<0.05). T was withheld (n=33) due to asymptomatic decline in LVEF (n=24), symptomatic heart failure (n=4) and both (n=5). Twenty-one with resolution of CHF (n=7) or LVEF recovery (n=14) were rechallenged. Cardiotoxicity recurred in 9 - asymptomatic decline in LVEF (n=8) and recurrent CHF (n=1). There were no cardiac-related deaths. Neither patient demographics nor CVS risk factors predicted for cardiotoxicity. Conclusions: This is one of the largest series reported in Asians receiving T. As previously reported, T-induced cardiotoxicity resulted in mostly asymptomatic reversible decline in LVEF. Our incidence of cardiotoxicity appeared higher (39.1%) in Asians and more importantly, almost half of the patients experienced cardiotoxicity upon rechallenge. It would be prudent to explore whether there is any difference in susceptibility to T-induced cardiotoxicity between the different races. [Table: see text] No significant financial relationships to disclose.

scholarly journals An Exploration of Heart Failure Risk in Breast Cancer Patients Receiving Anthracyclines with or without Trastuzumab in Thailand: A Retrospective Study

2021 ◽  
Vol 11 (3) ◽  
pp. 484-493
Author(s):  
Jukapun Yoodee ◽  
Aumkhae Sookprasert ◽  
Phitjira Sanguanboonyaphong ◽  
Suthan Chanthawong ◽  
Manit Seateaw ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cancer Patients ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Breast Cancer Patients ◽  
Ventricular Ejection Fraction ◽  
Factors Associated ◽  
Palliative Intent ◽  
Increased Risk

Anthracycline-based regimens with or without anti-human epidermal growth factor receptor (HER) 2 agents such as trastuzumab are effective in breast cancer treatment. Nevertheless, heart failure (HF) has become a significant side effect of these regimens. This study aimed to investigate the incidence and factors associated with HF in breast cancer patients treated with anthracyclines with or without trastuzumab. A retrospective cohort study was performed in patients with breast cancer who were treated with anthracyclines with or without trastuzumab between 1 January 2014 and 31 December 2018. The primary outcome was the incidence of HF. The secondary outcome was the risk factors associated with HF by using the univariable and multivariable cox-proportional hazard model. A total of 475 breast cancer patients were enrolled with a median follow-up time of 2.88 years (interquartile range (IQR), 1.59–3.93). The incidence of HF was 3.2%, corresponding to an incidence rate of 11.1 per 1000 person-years. The increased risk of HF was seen in patients receiving a combination of anthracycline and trastuzumab therapy, patients treated with radiotherapy or palliative-intent chemotherapy, and baseline left ventricular ejection fraction <65%, respectively. There were no statistically significant differences in other risk factors for HF, such as age, cardiovascular comorbidities, and cumulative doxorubicin dose. In conclusion, the incidence of HF was consistently high in patients receiving combination anthracyclines trastuzumab regimens. A reduced baseline left ventricular ejection fraction, radiotherapy, and palliative-intent chemotherapy were associated with an increased risk of HF. Intensive cardiac monitoring in breast cancer patients with an increased risk of HF should be advised to prevent undesired cardiac outcomes.

scholarly journals Systemic Lupus Erythematosus, Its Impact on Selected Cardiovascular Risk Factors, and Correlation with Duration of Illness: A Pilot Study

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Brygida Przywara-Chowaniec ◽  
Dominika Blachut ◽  
Jan Harpula ◽  
Marcin Bereś ◽  
Agnieszka Nowak ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Lupus Erythematosus ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Systemic Lupus ◽  
Ventricular Ejection Fraction ◽  
The Impact

Systemic lupus erythematosus is a rare autoimmune disease. It leads to an increased production of proinflammatory molecules that accelerates atherogenesis and could cause an endothelium dysfunction. The aim of the study was to assess cardiovascular risk factors such as BMI and lipid profile as well as left ventricular ejection fraction among patients with SLE, and a correlation of these factors with duration of the disease. Materials and Methods. The researched group consisted of patients with SLE, being under control of the outpatient clinic of cardiology. This group included 38 patients among whom 34 were women (56.17 ± 11.05 years) and 4 were men (65.50 ± 9.22 years). The control group consisted of 19 healthy women (53.31 ± 11.94 years) and 2 healthy men (38.51 ± 7.53 years). Measurements were taken in the same conditions by trained medical staff. Results. Excessive body weight (BMI >25 kg/m2) was more frequent in the SLE group, but it was not statistically significant (55.26% vs. 52.38%, p = 0.6159 ). LVEF values were lower in their searched group, and this factor showed statistical significance (53.92% ± 6.46 vs. 58.67% ± 4.69, p = 0.0044 ). Thickness of the IMT was higher and statistically important among patients with SLE, both in left (1.22 ± 0.27 mm vs. 0.7 ± 0.21 mm, p = 0.0001 ) and right common carotid artery (1.16 ± 0.26 mm vs. 0.59 ± 0.15 mm, p = 0.0001 ), compared to the controls. Conclusions. Patients with SLE are at greater risk of developing cardiovascular diseases as the illness progresses. The activity of the disease according to the SLEDAI-2K scale may have an impact on the LVEF values which was significantly decreased in the group with active disease, but further thorough investigation is required to fully evaluate the impact of individual components of the disease and its treatment on the CVD development and mortality.

Abstract 13677: Left Atrial Structure and Function in Relation to Incident Stroke/TIA and Dementia: The Multi-ethnic Study of Atherosclerosis

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Mohammadali Habibi ◽  
Mytra Zareian ◽  
Bharath Ambale Venkatesh ◽  
Sanaz Samiei ◽  
Elzbieta Chamera ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Left Atrial ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Peak Strain ◽  
Ventricular Ejection Fraction ◽  
Incident Dementia ◽  
And Function

Introduction: Increased left atrial (LA) size and reduced LA function are known predictors of atrial fibrillation (AF). Evidence also links increased LA size and stroke. We sought to examine the association of LA function, measured with cardiac magnetic resonance imaging (CMR) and incident stroke/TIA and dementia. Methods: This case-cohort study compared LA size and function in 180 MESA participants with incident Stroke/TIA and 95 with incident dementia, over a median follow up of 10.7 years, to 550 participants randomly selected from the whole MESA cohort. All individuals were free of clinical cardiovascular and major valvular heart disease. Phasic LA volumes, LA emptying fractions (LAEF) and peak strain were quantified in sinus rhythm using tissue-tracking CMR. Vascular neurologists adjudicated stroke events by medical record review. Dementia cases were identified using ICD9 codes from hospital records. Modified Cox proportional hazard models weighted for the stratified case-cohort sampling design was used to examine the associations. Results: Incident Stroke/TIA (age 67 ± 9 years, 45% male) and dementia cases (age 74 ± 6 years, 58% male) were older than the subcohort population (age: 61 ± 10, 49% male). In multivariable analysis adjusted for standard cardiovascular risk factors and left ventricular ejection fraction, lower peak LA strain and passive LAEF were associated with both incident stroke/TIA and dementia. After further adjustment for incident AF, the associations were attenuated for peak LA strain but remained significant for passive LAEF (HR for incident Stroke/TIA: 0.72 per SD 95% CI: 0.55-0.93, p=0.013 and for incident dementia: 0.59 per SD 95% CI: 0.37-0.95, p=0.031). Conclusions: Reduced LA conduit function was associated with incident Stroke/TIA and dementia independent of other cardiovascular risk factors and incident AF. Assessment of LA function may add further information in risk stratifying individuals at risk for stroke and dementia.

scholarly journals The Analysis of Arterial Stiffness in Heart Failure Patients in Comparison with Healthy Subjects and Patients with Cardiovascular Risk Factors

2019 ◽  
Vol 8 (10) ◽  
pp. 1721 ◽  
Author(s):  
Mauro Feola ◽  
Marzia Testa ◽  
Cinzia Ferreri ◽  
GianLuca Rosso ◽  
Arianna Rossi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Cardiovascular Risk ◽  
Arterial Stiffness ◽  
Cardiovascular Risk Factors ◽  
Healthy Subjects ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Ventricular Ejection Fraction

The arterial stiffness in the pathogenesis and clinical outcome in heart failure (HF) patients still needs to be clarified. An increased pulse wave velocity (PWV) in HF patients in comparison with healthy subjects and cardiovascular risk factors (CVRF) patients has been demonstrated. The aim of this study was to evaluate the arterial stiffness in HF patients in comparison to control populations. Methods: Consecutive patients admitted for decompensated heart failure underwent echocardiogram and evaluation of arterial stiffness by measuring the PWV and the augmentation index (AIx75). The arterial stiffness was also calculated in a control group formed by healthy volunteers and in CVRF subjects. Results: Fifty-nine HF patients (62% males; age 75 years) with mean left ventricular ejection fraction (LVEF) 38% and N-terminal pro B-type natriuretic peptide (NT-proBNP) (8111 pg/mL) entered the study. The HF population were compared with 22 healthy controls (age 58 years) and 20 CVRF patients (age 72 years). The analysis of PWV demonstrated a velocity of 10.6 m/s (9–12.1 m/s), 11.7 m/second (10.4–12.8 m/s), and 10.1 m/second (8.6–10.8m/s) in controls, CVRF, and HF patients (p = 0.01). AIx75 was seen to be higher in the CVRF group vs. HF patients (34% vs. 22%, p = 0.001). In HF patients PWV was inversely correlated with the glomerular filtration rate (r = –0.40; p = 0.002) and directly with central systolic pressure (SP) (r = 0.29; p = 0.02), brachial SP (r = 0.33; p = 0.01) as well as AIx75 correlated with GFR (r = −033; p = 0.01). Conclusion: PWV proved to be different in HF patients in comparison with CVRF/healthy population. The strongest correlation was revealed between the values of PWV/AIx75 and renal function.

scholarly journals Difference in Correlation Coefficient between Heart Rate Variability and Mechanical Dispersion in Breast Cancer Patients with and without Cardiovascular Risk Factors Post Anthracycline Chemotherapy

2020 ◽  
Vol 6 (1) ◽  
pp. 23-28
Author(s):  
Evi Fatimah ◽  
Erwan Martanto ◽  
Mohammad Iqbal ◽  
Januar W. Martha ◽  
M. Rizki Akbar
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Cancer Patients ◽  
Left Ventricular ◽  
Left Ventricular Dyssynchrony ◽  
Breast Cancer Patients ◽  
Group I ◽  
Group Ii

Background: Sympathetic hyperactivity is one of the several factors that influence left ventricular dyssynchrony post anthracycline. Cardiovascular risk factors affect the acceleration of left ventricular dyssynchrony. The purpose of this study is to assess the difference in correlation coefficient between HRV and mechanical dispersion in breast cancer patients with and without cardiovascular risk factors after anthracycline administration.Method: This was a cross sectional study with linear regression analysis conducted at Hasan Sadikin General Hospital Bandung between July-October 2018. Subjects were breast cancer patients who had received 6 cycles of FAS and were divided into 2 groups. Group I was patients with breast cancer who have cardiovascular risk factors and group II was without cardiovascular risk factors. Sympathetic hyperactivity was assessed using HRV baseline frequency with minimum duration of recording and left ventricular dyssynchrony was assessed using MD method by echocardiography.Result: This study involved 66 patients. Group I (n=34, age 50.3±6.3 years) and group II (n=32, age 48.5±9 years). The median of LF/HF ratio was 2.7 ms2 (group I) and 1.9 ms2 (group II). MD value in group I and group II was 52.2±13.6 ms and 45.7±8.8 ms, respectively. The result of linear regression analysis showed positive correlation between the LF/HF ratio and MD in group I (r=0.546, p=0.001) and group II (r=0.423, p=0.016) after adjusting three confounding factors (systolic blood pressure, cumulative dose of Doxorubicin, and age).Conclusion: Correlation coefficient of HRV with mechanical dispersion in post anthracycline breast cancer patients in those with cardiovascular risk factorswas worse compared to those without cardiovascular risk factors but was not statistically significant.

Prevalence of trastuzumab-induced cardiotoxicity in Uruguayan HER2-positive breast cancer patients treated in a real life setting during a 10 year period.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e12537-e12537
Author(s):  
Natalia Camejo ◽  
Cecilia Castillo ◽  
Nora Artagaveytia ◽  
Crisitian Etcheverría ◽  
Jessica Ferradaz ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Cardiovascular Risk ◽  
Cardiac Toxicity ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Chi Square ◽  
Ventricular Ejection Fraction ◽  
Her 2 ◽  
Positive Breast Cancer

e12537 Background: To estimate the prevalence of Trastuzumab (TTZ) induced cardiotoxicity in Uruguayan women diagnosed with early HER – 2 positive breast cancer (BC) over a period of ten years, treated under the financial coverage of the National Resource Fund (FNR). Methods: A prospective descriptive observational study based on the analysis of an anonymized database provided by the FNR of Uruguayan HER-2 positive early BC patients treated with TTZ between 2006 and 2016. Variables analyzed included: age, menopausal status, stage, presence of cardiovascular risk factors, use or not of anthracyclines, left ventricular ejection fraction prior and during treatment, and temporary or permanent suspension of treatment. Statistical analysis was performed using SPSS Statistics version 25. The variables were assessed through the use of measures of central tendency, dispersion, contingency tables and proportions. To analyze the relationship between the different variables, the Chi-Square test of independence was performed. Results: The analysis included 1401 patients diagnosed with HER-2 + stage I to III breast cancer who received adjuvant TTZ. The mean age at diagnosis was 52.45 years. The prevalence of cardiotoxicity in evaluable patients (1065 pts) was 20.3%. The proportion of patients who had symptomatic heart failure was 3% (32 pts) and in those who discontinued treatment for asymptomatic cardiac toxicity managed to resume trastuzumab prevalence was 92.6 %. About 9,7 % (21 pts) of patients had drop of left ventricular ejection fraction (LVEF) below 50%, whilst 10% drop of LVEF below their baseline levels were found in 75% of patients (162 pts) There is significant difference in the risk of cardiotoxicity according to the type of chemotherapy (anthracycline containing vs non-anthracycline based) (Chi-square = 3.9, p-value < 0.005). There was no evidence of a relationship between cardiovascular risk factors and the development of cardiotoxicity as well there was no evidence between sequential or concurrent use of TTZ with chemotherapy. Conclusions: The prevalence of cardiotoxicity in this study was similar to that reported internationally. The majority of patients did not develop cardiac toxicity and those who presented it did so asymptomatically and reversibly.

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