Role of Early Left Atrial Functional Decline in Predicting Cardiotoxicity in HER2 Positive Breast Cancer Patients Treated With Trastuzumab

Cardiovasc Toxicol. 2024 Jun;24(6):550-562. doi: 10.1007/s12012-024-09861-6. Epub 2024 May 2.

Abstract

Trastuzumab is widely used in HER2 breast cancer. However, it may cause left ventricular (LV) dysfunction. A decrease in LV global longitudinal strain (GLS) has been previously demonstrated to be a good predictor of subsequent cancer therapy related dysfunction (CTRCD). Left atrial morphological remodeling during Trastuzumab therapy has also been shown. The aim of this study is exploring the relationship between early changes in left atrial function and the development of Trastuzumab-induced cardiotoxicity. Consecutive patients with diagnosis of HER2+non-metastatic breast cancer treated with Trastuzumab were prospectively enrolled. A clinical, conventional, and advanced echocardiographic assessment was performed at baseline and every three months, until a one-year follow-up was reached. One-hundred-sixteen patients completed the 12 months follow-up, 10 (9%) cases of CTRCD were observed, all after the sixth month. GLS and LVEF significantly decreased in the CTRCD group at 6 months of follow-up, with an earlier (3 months) significant worsening in left atrial morpho-functional parameters. Systolic blood pressure, early peak atrial longitudinal strain (PALS), peak atrial contraction (PACS) and left atrial volume (LAVI) changes resulted independent predictors of CTRCD at multivariable logistic regression analysis. Moreover, early changes in PALS and PACS resulted good predictors of CTRCD development (AUC 0.85; p = 0.008, p < 0.001 and 0.77; p = 0.008, respectively). This prospective study emphasizes that the decline in PALS and PACS among trastuzumab-treated patients could possibly increase the accuracy in identifying future CTRCD in non-metastatic HER2 breast cancer cases, adding predictive value to conventional echocardiographic assessment.

Keywords: Breast cancer; CTRCD; Cardiotoxicity; PALS; Trastuzumab.

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents, Immunological* / adverse effects
  • Atrial Function, Left* / drug effects
  • Atrial Remodeling / drug effects
  • Breast Neoplasms* / drug therapy
  • Cardiotoxicity*
  • Female
  • Heart Atria / diagnostic imaging
  • Heart Atria / drug effects
  • Heart Atria / physiopathology
  • Heart Diseases / chemically induced
  • Heart Diseases / diagnostic imaging
  • Heart Diseases / physiopathology
  • Humans
  • Middle Aged
  • Predictive Value of Tests
  • Prospective Studies
  • Receptor, ErbB-2* / metabolism
  • Risk Assessment
  • Risk Factors
  • Stroke Volume / drug effects
  • Time Factors
  • Trastuzumab* / adverse effects
  • Treatment Outcome
  • Ventricular Dysfunction, Left / chemically induced
  • Ventricular Dysfunction, Left / diagnostic imaging
  • Ventricular Dysfunction, Left / physiopathology
  • Ventricular Function, Left* / drug effects

Substances

  • ERBB2 protein, human