Bergamini Corinna, Dolci Giulia, Rossi Andrea, Torelli Flavia, Ghiselli Luca, Trevisani Laura, Vinco Giulia, Truong Stella, La Russa Francesca, Golia Giorgio, Molino Annamaria, Benfari Giovanni, Ribichini Flavio Luciano
Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
Division of Oncology, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy.
Clin Cardiol. 2018 Mar;41(3):349-353. doi: 10.1002/clc.22872. Epub 2018 Mar 22.
Trastuzumab (TZ) therapy requires careful monitoring of left ventricular (LV) ejection fraction (LVEF) because it can be potentially cardiotoxic. However, LVEF is an imperfect parameter and there is a need to find other variables to predict cardiac dysfunction early. Left atrium (LA) enlargement has proven to be a powerful predictor of adverse outcomes in several disease entities.
Baseline LA volume enlargement might predict TZ-related LV dysfunction.
HER2-positive breast cancer patients receiving TZ and undergoing transthoracic echocardiography at baseline and at follow-up every 3 months were retrospectively recruited. One-hundred sixty-two patients formed the study population.
Baseline LAVI was dilated in 14 patients (8.6%). Mean follow-up was 14 ± 4 months. Cardiotoxicity occurred in 24 patients (14.8%). LAVI was an independent predictor of TZ-induced LV dysfunction in a clinical model, after adjustment for age and hypertension (odds ratio per 5-mL/m LAVI increase: 1.34, 95% confidence interval: 1.03-1.82, P = 0.03); and in a hemodynamic model, including ventricular sizes and systolic blood pressure level (odds ratio per 5-mL/m LAVI increase: 1.34, 95% confidence interval: 1.01-1.81, P = 0.04). The predicted probability of developing cardiotoxicity increased progressively, in parallel with LAVI values.
Baseline LA dilatation emerges as a condition associated with the development of cardiotoxicity in HER2-positive breast cancer patients treated with TZ.
曲妥珠单抗（TZ）治疗需要密切监测左心室（LV）射血分数（LVEF），因为它可能具有潜在的心脏毒性。然而，LVEF是一个不完善的参数，需要寻找其他变量来早期预测心脏功能障碍。左心房（LA）扩大已被证明是几种疾病实体不良结局的有力预测指标。
基线LA容积扩大可能预测TZ相关的LV功能障碍。
回顾性招募接受TZ治疗且在基线和每3个月随访时接受经胸超声心动图检查的HER2阳性乳腺癌患者。162名患者构成研究人群。
14名患者（8.6%）基线LAVI扩大。平均随访时间为14±4个月。24名患者（14.8%）发生心脏毒性。在调整年龄和高血压后，在临床模型中，LAVI是TZ诱导的LV功能障碍的独立预测指标（每增加5 mL/m LAVI的比值比：1.34，95%置信区间：1.03 - 1.82，P = 0.03）；在血流动力学模型中，包括心室大小和收缩压水平（每增加5 mL/m LAVI的比值比：1.34，95%置信区间：1.01 - 1.81，P = 0.04）。发生心脏毒性的预测概率与LAVI值平行逐渐增加。
基线LA扩张是接受TZ治疗的HER2阳性乳腺癌患者发生心脏毒性的相关因素。
