P662S' velocity measured by tissue Doppler imaging is more sensitive indicator of left ventricular systolic function than ejection fraction in breast cancer patients receiving tratsuzumab therapy

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Purpose: Tratsuzumab is now widely used anticancer agent to improved survival of advanced breast cancer patients. However, symptomatic heart failure is a serious side effect of tratsuzumab and anthracycline exposure is a risk factor of tratsuzumab-related cardiotoxicity.Methods: We investigated 77 breast cancer patients who were receiving tratsuzumab therapy. All patients underwent 2D and Doppler echocardiography at baseline and every 3 to 4 months thereafter.Results: Mean age was 52±9 (31-75) years. 76 (98.7%) patients were female. Tratsuzumab was used as adjuvant chemotherapy in 71 patients (92.2%). 67 patients (87.0%) had been exposured to anthracyclines [mean cumulative dose, 241.6±38.8 (200-480) mg/kg/m2]. 50 (64.9%) patients had received radiation therapy. Symptomatic CHF occurred in 1 patient (1.3%) and another 2 patients (2.6%) discontinued tratsuzumab due to decline of LV EF ≥10% without CHF symptoms. Whereas mean baseline and follow-up LV EF showed no significant change (58.8±3.8% and 58.2±5.7%, p=NS), S' velocities assessed by tissue Doppler imaging were significantly decreased (7.14±1.09 cm/s and 6.74±1.05 cm/s, p=0.002). E/E' ratio also showed trend of increase (10.3±2.7 vs.10.9±3.2, p=0.045). In patients with anthracycline exposure, these findings were consistently shown.Conclusions: The incidence of tratsuzumab-related symptomatic heart failure was low. In patients receiving tratsuzumab therapy, Doppler echocardiographic parameters including S' velocity and E/E' ratio should be assessed for surveillance of cardiac function in addition to LV EF measurement.

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