University of Toronto, Toronto, Canada.
Mount Sinai Hospital, Toronto, Canada.
Eur Radiol. 2022 Jun;32(6):4234-4242. doi: 10.1007/s00330-021-08466-9. Epub 2022 Jan 6.
We evaluated left atrial (LA) remodeling using cardiac MRI (CMR) in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer during and after trastuzumab therapy.
In this prospective 2-center longitudinal study, 41 women with HER2-positive breast cancer received adjuvant trastuzumab for 12 months, in addition to standard chemotherapy. Serial CMRs were performed at baseline, 6, 12, and 18 months after initiation of trastuzumab. LA volumes were measured by a blinded reader. Linear mixed model was used to evaluate longitudinal changes.
Of 41 women (mean age 52 ± 11 [SD] years; 56% received anthracycline), one patient experienced trastuzumab-induced cardiotoxicity (TIC) for which trastuzumab was interrupted for one cycle. Mean baseline left ventricular ejection fraction (LVEF) was 68.0 ± 5.9% and LA ejection fraction (LAEF) was 66.0 ± 6.6%. Compared to baseline, LAEF decreased significantly at 6 months (62.7 ± 5.7%, p = 0.027) and 12 months (62.2 ± 6.1%, p = 0.003), while indexed LA minimum volume (LAmin) significantly increased at 12 months (11.6 ± 4.9 ml/m vs 13.8 ± 4.5 ml/m, p = 0.002). At 18 months, all changes from baseline were no longer significant. From baseline to 6 months, change in LAEF correlated with change in LVEF (Spearman's r = 0.41, p = 0.014). No significant interactions (all p > 0.10) were detected between time and anthracycline use for LA parameters.
Among trastuzumab-treated patients with low incidence of TIC, we observed a small but significant decline in LAEF and increase in LAmin that persisted for the duration of therapy and recovered 6 months after therapy cessation. These findings suggest that trastuzumab has concurrent detrimental effects on atrial and ventricular remodeling.
• In trastuzumab-treated breast cancer patients evaluated by cardiac MRI, left atrial ejection fraction declined and minimum volume increased during treatment and recovered to baseline after trastuzumab cessation. • Changes in left atrial ejection fraction correlated with changes in left ventricular ejection fraction in the first 6 months of trastuzumab treatment. • Trastuzumab therapy is associated with concurrent detrimental effects on left atrial and ventricular remodeling.
我们通过心脏 MRI（CMR）评估了曲妥珠单抗治疗期间和之后人表皮生长因子受体 2（HER2）阳性乳腺癌患者的左心房（LA）重构。
在这项前瞻性的 2 中心纵向研究中，41 名 HER2 阳性乳腺癌患者在接受标准化疗的基础上，接受曲妥珠单抗辅助治疗 12 个月。在曲妥珠单抗开始后基线、6、12 和 18 个月进行连续 CMR。由盲法读者测量 LA 容积。使用线性混合模型评估纵向变化。
在 41 名女性（平均年龄 52±11[SD]岁；56%接受蒽环类药物治疗）中，1 名患者发生曲妥珠单抗诱导的心脏毒性（TIC），因此中断曲妥珠单抗治疗 1 个周期。平均基线左心室射血分数（LVEF）为 68.0±5.9%，LA 射血分数（LAEF）为 66.0±6.6%。与基线相比，LAEF 在 6 个月（62.7±5.7%，p=0.027）和 12 个月（62.2±6.1%，p=0.003）时显著降低，而指数化 LA 最小容积（LAmin）在 12 个月时显著增加（11.6±4.9ml/m 比 13.8±4.5ml/m，p=0.002）。在 18 个月时，所有与基线相比的变化均不再显著。从基线到 6 个月，LAEF 的变化与 LVEF 的变化相关（Spearman's r=0.41，p=0.014）。LA 参数的时间和蒽环类药物使用之间未检测到显著的相互作用（所有 p>0.10）。
在 TIC 发生率较低的曲妥珠单抗治疗患者中，我们观察到 LAEF 略有但显著下降，LAmin 增加，这种情况持续到治疗期间，并在曲妥珠单抗停药后 6 个月恢复。这些发现表明，曲妥珠单抗对心房和心室重构具有同时的不良影响。
• 在接受心脏 MRI 评估的曲妥珠单抗治疗的乳腺癌患者中，左心房射血分数在治疗期间下降，最小容积增加，并在曲妥珠单抗停药后恢复至基线。• 在曲妥珠单抗治疗的前 6 个月内，左心房射血分数的变化与左心室射血分数的变化相关。• 曲妥珠单抗治疗与左心房和心室重构的同时不良影响有关。
