Echocardiographic Assessment of Ventricular Cardiomyopathy in Patients with Breast Cancer under Trastuzumab Chemotherapy

Breast cancer is the most common cancer and the leading cause of cancer-related death among women worldwide. Breast cancer treatment has been improved by the development of targeted chemotherapies such as antibodies against HER2 receptors and now Trastuzumab is the standard treatment for HER2 positive breast cancer. Cardiotoxicity is the most prominent adverse effect of Trastuzumab that restricts the usage of this drug. This study is designed to assess cardiomyopathy in patients with breast cancer under Trastuzumab chemotherapy with special respect to both right and left ventricles. A total number of 38 cases were evaluated. Echocardiography was done at the baseline and three to six months after the initiation of Trastuzumab chemotherapy. According to the second echocardiography 24 cases (63.8%) developed cardiotoxicity based on decrease in ejection fraction or decrease in the absolute value of the left and/or right ventricular Global Longitudinal Strain (LV and/or RV GLS). There was a significant difference between the mean values of echocardiographic indices including RVSm, RV Tei-index, LV Tei-index, RV GLS, LV GLS, LVEF, MAPSE, and TAPSE before and after chemotherapy (the p-value for comparison of MAPSE was 0.006, and the p-value for comparison of other parameters was <0.001). There was no significant difference in terms of cardiotoxicity between the group that received radiotherapy in addition to chemotherapy and the group that did not receive radiotherapy. In conclusion, the best way to minimize Trastuzumab-induced cardiotoxicity is intensive follow-up by echocardiography to detect cardiac impairments in the early stages. Also, the study demonstrated the uniqueness of longitudinal strain especially LV-GLS for early detection of cardiotoxicity.