Heart remodeling induced by adjuvant trastuzumab-containing chemotherapy for breast cancer overexpressing human epidermal growth factor receptor type 2: A prospective study

We aimed to investigate the cardiac changes in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer treated with trastuzumab in an adjuvant setting. Two hundred and fifty-three women with HER2-positive breast cancer were included. The assessment of cardiovascular system and echocardiography were performed and compared at baseline, at the termination of trastuzumab therapy and 6 months latter. Left heart remodeling was defined arbitrary as the change in at least one of the analyzed echocardiographic parameters of ≥standard deviation (SD) (in model I) or ≥2×SD (in model II) after 6-month follow-up. After 6-month follow-up 39 (31.7%), 27 (22%), 14 (11.4%), 10 (8.1%), 5 (4.1%) and 1 (0.8%), women had at least one parameter with a change exceeding mean difference ≥SD, respectively; and 30 (24.4%), 9 (7.5%), 3 (2.4%), 2 (1.6%) 1 (0.8%) exceeding mean difference ≥2SD. In stepwise multivariate regression analysis sedentary life style (OR16.7, p = 0.003), positive cardiovascular family history (OR 6,9; p = 0.013) and left ventricular ejection fraction change after 3 months (OR 1.2; p = 0.007) were independent predictors of left heart remodeling in model I, whereas hypertension (OR 5.6; p = 0.06) and positive cardiovascular family history (OR 3.9; p = 0.032) were independent predictors of heart remodeling in model II. In conclusion, trastuzumab induces LV and left atrial cavity dilatation together with LV systolic function impairment.

The aim of the study was to investigate the cardiac changes in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer treated with trastuzumab in an adjuvant setting. On the basis of obtained results we showed that trastuzumab induced LV and left atrial cavity dilatation together with LV systolic function impairment. The picture presents the individual changes from baseline after trastuzumab therapy termination (A) and after 6 months of follow-up (B) in ECHO parameters.Figure optionsDownload high-quality image (120 K)Download as PowerPoint slide