Fallah-Rad Nazanin, Lytwyn Matthew, Fang Tielan, Kirkpatrick Iain, Jassal Davinder S
Institute of Cardiovascular Sciences, St, Boniface Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada.
J Cardiovasc Magn Reson. 2008 Jan 22;10(1):5. doi: 10.1186/1532-429X-10-5.
Trastuzumab (Herceptin), an antagonist to the human epidermal growth factor 2 (HER2) receptor significantly decreases the rates of breast cancer recurrence and mortality by 50%. Despite therapeutic benefits, the risk of cardiotoxicity with trastuzumab ranges from 10-15% when administered sequentially following anthraycline chemotherapy. Little is known about the utility of cardiac magnetic resonance (CMR) in the assessment of trastuzumab mediated cardiomyopathy.
Between 2005-2006 inclusive, 160 breast cancer patients were identified at a single tertiary care oncology centre. Of the total population, 10 patients (mean age 40 +/- 8 years) were identified with trastuzumab induced cardiomyopathy, based on a LVEF less than 40% on serial MUGA or echocardiography. CMR was performed in all patients to determine LV volumes, systolic function and evidence of late gadolinium enhancement (LGE). At the time of diagnosis of trastuzumab induced cardiomyopathy, the mean LVEF was 29 +/- 4%. Subepicardial linear LGE was present in the lateral portion of the left ventricles in all 10 patients.
LGE-CMR is a novel way of detecting early changes in the myocardium due to trastuzumab induced cardiotoxicity.
曲妥珠单抗（赫赛汀）是一种针对人表皮生长因子2（HER2）受体的拮抗剂，可使乳腺癌复发率和死亡率显著降低50%。尽管有治疗益处，但在蒽环类化疗后序贯使用曲妥珠单抗时，发生心脏毒性的风险为10%-15%。关于心脏磁共振成像（CMR）在评估曲妥珠单抗介导的心肌病中的作用，人们了解甚少。
在2005年至2006年期间，于一家三级医疗肿瘤中心确定了160例乳腺癌患者。在全部患者中，基于连续门控心血池显像（MUGA）或超声心动图检查显示左室射血分数（LVEF）低于40%，确定有10例患者（平均年龄40±8岁）发生了曲妥珠单抗诱导的心肌病。对所有患者均进行了CMR检查，以确定左室容积、收缩功能及钆延迟强化（LGE）情况。在诊断曲妥珠单抗诱导的心肌病时，平均LVEF为29±4%。所有10例患者左心室侧壁均存在心外膜下线性LGE。
LGE-CMR是检测曲妥珠单抗诱导的心脏毒性所致心肌早期变化的一种新方法。
