Kılıçaslan Barış, Özdoğan Öner, Demir Pişkin Gönül, Kahya Eren Nihan, Dursun Hüseyin
Clinic of Cardiology, Tepecik Research and Training Hospital; İzmir-Turkey.
Anatol J Cardiol. 2015 Feb;15(2):143-8. doi: 10.5152/akd.2014.5220. Epub 2014 Apr 2.
Left ventricular (LV) dysfunction after trastuzumab treatment in erb-2 breast cancer cases has been fully investigated. However, there is not enough data about the effect of trastuzumab treatment on right ventricular (RV) functions. This study is designed to evaluate the right heart changes by performing echocardiography after trastuzumab treatment in patients with erb-2 breast cancer.
Forty-two consecutive breast cancer patients with erb-2 overexpression mean age 50.4 ± 11.6 years who were decided to receive trastuzumab treatment were enrolled. Echocardiographic examinations including 2-D, spectral, and tissue Doppler measurements were performed at the baseline (T1) and repeated after 6 months (T2).
Tricuspid annular plane systolic excursion (TAPSE) was decreased, RV myocardial performance index (RVMPI) and tricuspid E/e' ratio was increased after trastuzumab treatment (1.84 vs. 2.14; p<0.01) (0.46 vs. 0.56, p<0.01) (4.4 ± 1.07 vs. 5.08 ± 1.46; p=0.04). Median serum NT-ProBNP levels, troponin I, and hs-CRP levels were similar between the groups. LVEF and TAPSE were negatively correlated with dosage of trastuzumab (r=-0.392, p=0.04; r=-0.522, p=0.006). There was a stepwise decrease in LVEF when trastuzumab used with anthracyclines however this not reached statically significant (62.4 ± 2, 60 ± 4.5; p=0.06).
In our study; we observed a trend of RV deterioration after trastuzumab treatment. These preliminary RV changes were demonstrated by using TAPSE, RV tissue Doppler imaging derived MPI and E/e' ratio parameters by echocardiography and these parameters could also use as markers of trastuzumab toxicity in this population.
已对erb-2型乳腺癌患者接受曲妥珠单抗治疗后的左心室（LV）功能障碍进行了充分研究。然而，关于曲妥珠单抗治疗对右心室（RV）功能影响的数据尚不充分。本研究旨在通过对erb-2型乳腺癌患者进行曲妥珠单抗治疗后行超声心动图检查来评估右心变化。
连续纳入42例决定接受曲妥珠单抗治疗的erb-2过表达乳腺癌患者，平均年龄50.4±11.6岁。在基线时（T1）进行包括二维、频谱和组织多普勒测量的超声心动图检查，并在6个月后（T2）重复检查。
曲妥珠单抗治疗后三尖瓣环平面收缩期位移（TAPSE）降低，右心室心肌性能指数（RVMPI）和三尖瓣E/e'比值升高（1.84对2.14；p<0.01）（0.46对0.56，p<0.01）（4.4±1.07对5.08±1.46；p=0.04）。两组间血清NT-ProBNP水平中位数、肌钙蛋白I和高敏C反应蛋白水平相似。左心室射血分数（LVEF）和TAPSE与曲妥珠单抗剂量呈负相关（r=-0.392，p=0.04；r=-0.522，p=0.006）。当曲妥珠单抗与蒽环类药物联用时LVEF呈逐步下降趋势，但未达到统计学显著性（62.4±2，60±4.5；p=0.06）。
在我们的研究中；我们观察到曲妥珠单抗治疗后右心室恶化的趋势。这些右心室的初步变化通过超声心动图使用TAPSE、右心室组织多普勒成像得出的MPI和E/e'比值参数得以证实，并且这些参数也可作为该人群中曲妥珠单抗毒性的标志物。
