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Open Access 02-05-2024 | Trastuzumab | Research

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

Authors: Corinna Bergamini, Lorenzo Niro, Paolo Springhetti, Luisa Ferri, Laura Trento, Ilaria Minnucci, Caterina Maffeis, Elvin Tafciu, Andrea Rossi, Elena Fiorio, Giovanni Benfari, Flavio Ribichini

Published in: Cardiovascular Toxicology | Issue 6/2024

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.

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Title: Role of Early Left Atrial Functional Decline in Predicting Cardiotoxicity in HER2 Positive Breast Cancer Patients Treated With Trastuzumab
Authors: Corinna Bergamini
Lorenzo Niro
Paolo Springhetti
Luisa Ferri
Laura Trento
Ilaria Minnucci
Caterina Maffeis
Elvin Tafciu
Andrea Rossi
Elena Fiorio
Giovanni Benfari
Flavio Ribichini
Publication date: 02-05-2024
Publisher: Springer US
Keywords: Trastuzumab
Breast Cancer
Breast Cancer
Anthracycline
Published in: Cardiovascular Toxicology / Issue 6/2024
Print ISSN: 1530-7905
Electronic ISSN: 1559-0259
DOI: https://doi.org/10.1007/s12012-024-09861-6

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

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