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Introduction Peripartum cardiomyopathy (MPP) is a type of cardiomyopathy characterized by heart failure secondary to left ventricular systolic dysfunction during the last month of pregnancy or in the first 5 months of puerperium without other apparent etiology, being a diagnosis of exclusion. The left ventricle is not always dilated, but the fraction of left ventricular ejection is always less than 45%. The natural history and prognosis of the disease is diverse. Ventricular dysfunction is usually transient and normalizes at 3-6 months in up to 60% of cases. Mortality is variable, with reports ranging from 0 to 28%, affecting more certain ethnic groups, in patients with persistent ventricular dysfunction, evidence of the efficacy of a specific treatment beyond optimal medical therapy for heart failure is limited. Clinical case We present the clinical case of a 22-year-old woman, who was referred to the our institute with an acute heart failure syndrome two months after the end of her first pregnancy. On admission to the hospital, dilated cardiomyopathy and intracavitary thrombi were documented by transthoracic echocardiography (TTE) with dilatation and eccentric left ventricular hypertrophy, generalized hypokinesia and mobile thrombi inside, the largest of 34x16mm with severe left ventricular dysfunction 3D LVEF of 28% and global longitudinal strain (GLS) of -5.8%, pulmonary hypertension and right ventricular dysfunction with severe functional tricuspid regurgitation. Other specific etiologies of dilated cardiomyopathy were investigated and discarded, finally establishing the diagnosis of peripartum cardiomyopathy. The support management was carried with inotropic, diuretic, supplemental oxygen and parenteral anticoagulation was initiated, with gradual improvement. Subsequently, optimal medical treatment was started for heart failure, cabergoline and vitamin K antagonist. He was released to his home on II NYHA. Two months later she presented with progressive dyspnea, increased abdominal perimeter. On March 14, 2018, a TTE was performed, with absence of improvement in conventional and advanced ventricular function parameters. Apical thrombi of smaller size compared with previous study, severe left ventricular dysfunction, which worsened with respect to the previous echocardiogram, with 3D LVEF of 25% and GLS 3.7% Discussion We present the case of a woman with MPP, in whom persistent left ventricular dysfunction after 6 months of diagnosis, although cabergoline scheme in addition to optimal medical management for heart failure, with no improvement. In patients who dont present an adequate response to the management, it is necessary to consider enlisting for heart transplantation. Abstract P626 Figure. TTE, severe ventricular dysfunction

Background: Even when there are free schemes of anthracyclines, the biological subtype HER2+ can be exposed to cardiotoxic drugs anthracyclines (A) and/or trastuzumab(H). It has been demonstrated that the LVEF is not sensitive to detect early cardiac changes and could be within normal ranges but with irreversible cardiac dysfunction. 2D speckle tracking and cardiac biomarkers (TnI and NT-proBNP) have shown more sensitivity to define early myocardial damage. Adjuvant trial FinHER suggests lower cardiotoxicity (0.5%) when taxanes (T)+H are given before A. Our objectives were: 1)To show higher sensitivity of the longitudinal strain in the echo to detect cardiotoxicity compared to the LVEF 2)To describe if there are any differences in the cardiotoxicity in relation with the chemotherapy sequence used. Patients and methods: A retrospective cohort of patients diagnosed with breast cancer from February 2008 to January 2016 was obtained, in which 46 patients with HER2 positive breast cancer were included, most in the context of neoadjuvant or adjuvant chemotherapy treated with sequential chemotherapy (A→T+H vs T+H→A), with a cumulative dose of 240 mg/m2 of doxorubicin. A basal echo was done, as well at 3, 6, 9, 12 months after the beginning of the chemotherapy to determine LVEF and early cardiac damage parameters, such as longitudinal strain. Cardiotoxicity was determined with a symptomatic HF with a decline of LVEF >5% or LVEF ≤55% or asymptomatic HF with a decline ≥10% or in LVEF or LVEF ≤55%. A fall ≥15% was considered a significant decline of the longitudinal strain Results: 1 patient (2.1%)presented symptomatic HF (NYHA III). Asymptomatic cardiotoxicity was present in 9 patients (19.6%), 9 (19.6%), 11 (23.9%), and 13 (28.3%) at the 3, 6, 9, and 12 months respectively. The mean LVEF were (66±6.6), (63±9.0), (65±7.0), (65±6.4), and (63±6.9) at the basal, 3, 6, 9, and 12 months measurements respectively, with a non-significant “p” value. Significant decline in the longitudinal strain was observed in 10 patients (21.7%, p=0.012), in 13 patients (28.3%, p=0.034), in 15 patients (32.6%, p=0.95), and in 18 patients (39.1%, p=0.07), at the 3, 6, 9, and 12 months measurements respectively. When comparing the cardiotoxicity group vs the non cardiotoxicity groups no significant differences were observed with other risk factors as: HTN, dyslipidemia, carbohydrate intolerance, DM, radiotherapy, weight, cumulative doses of A, systolic-diastolic BP, glc levels, HDL, TG, and BMI. In the logistic regression analysis the longitudinal strain decline (≥15%) basal vs 3 months measurement had a OR 7.63 CI 95%(1.04-55.86) and the A→T + H sequence OR 7.7 CI 95%(1.076-55.43), were kept as independent variables for cardiotoxicity. Conclusions: As reported in literature the decline in the longitudinal strain was more sensitive than the LVEF to predict cardiotoxicity, thus this would allow to identify the highest risk individuals and to start a cardioprotective intervention. Due to the retrospective character of our study, we believe that in the neoadjuvant or adjuvant chemotherapy setting of sequential chemotherapy there is the need of prospective studies that evaluate the subclinical cardiotoxicity with more sensitive parameters to confirm our data. Citation Format: Pérez-Montessoro V, Poblano-Aguilar I, Galindo-Uribe J, Vásquez-Ortiz Z, Armengol-Alonso A. HER2 positive breast cancer and subclinical cardiotoxicity by echocardiogram 2D Strain, Do chemotherapy sequence matter? [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-11-06.

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