Trastuzumab chemotherapy subclinical cardiotoxicity in patients with breast cancer: A two-dimensional speckle tracking echocardiography study

Introduction Trastuzumab chemotherapy has been associated with left ventricular (LV) dysfunction. We aimed to assess early changes in LV and right ventricular (RV) mechanics associated with trastuzumab treatment for breast cancer. As well as explore whether early changes in 2-dimensional (2D)-speckle tracking echocardiography (STE) could predict later chemotherapy-induced cardiotoxicity. Methods Thirty-one patients with breast cancer who received Trastuzumab treatment were included. Echocardiograms were available for analysis with 2D-STE at the following time points: pretreatment (T0), 4 months (T1), and 12 months (T2). All patients had a normal pretreatment LV ejection fraction (LVEF). Cardiotoxicity was defined as a decrease in LVEF of at least 10 percentage points from baseline on follow-up echocardiography. Results Cardiotoxicity developed in 6 of the 31 patients (19%). The mean (±SD) LVEF at T0 was 66% (± 6); at T1 60% (± 7); and at T2, 54% (± 6). Global longitudinal strain (GLS) at T1 was the strongest indicator of subsequent cardiotoxicity (area under the curve, 0.85; cutoff value, −14.7; sensitivity, 91%; specificity, 82%; P = 0.003). The average 2D LV GLS was −20.58% (± 2.2) with a statistically significant decrease at T1 and T2 (LVGLS −19.35 (± 2.1) and−18.55 (± 2.3), P  Conclusion Trastuzumab treatment leads to early deterioration of LV GLS and circumferential strain. Right ventricular GLS and radial strain were also affected. Early changes in GLS are good predictors of subsequent development of trastuzumab-induced cardiotoxicity.