Comprehensive Assessment of Changes in Left Ventricular Diastolic Function With Contemporary Breast Cancer Therapy

Upshaw, Jenica N.; Finkelman, Brian S.; Hubbard, Rebecca A.; Smith, Amanda M.; Narayan, Hari K.; Arndt, Linzi; Domchek, Susan M.; DeMichele, Angela; Fox, Kevin R.; Shah, Payal D.; Clark, Amy S.; Bradbury, Angela R.; Matro, Jennifer M.; Adusumalli, Srinath; Carver, Joseph R.; Ky, Bonnie

doi:10.1016/j.jcmg.2019.07.018

Cited by 97 publications

(82 citation statements)

References 31 publications

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“…In breast cancer patients receiving anthracyclines with or without trastuzumab, diastolic dysfunction has been reported to precede systolic dysfunction and CTRCD ( 47 ). We recommend that diastolic assessment should be undertaken in all baseline echocardiograms.…”

Section: Function Assessment By Echocardiographymentioning

confidence: 99%

British Society for Echocardiography and British Cardio-Oncology Society guideline for transthoracic echocardiographic assessment of adult cancer patients receiving anthracyclines and/or trastuzumab

Dobson¹,

Ghosh

et al. 2021

Echo Res Pract

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The subspecialty of cardio-oncology aims to reduce cardiovascular morbidity and mortality in patients with cancer or following cancer treatment. Cancer therapy can lead to a variety of cardiovascular complications, including left ventricular systolic dysfunction, pericardial disease, and valvular heart disease. Echocardiography is a key diagnostic imaging tool in the diagnosis and surveillance for many of these complications. The baseline assessment and subsequent surveillance of patients undergoing treatment with anthracyclines and/or human epidermal growth factor receptor (HER) 2-positive targeted treatment (e.g., trastuzumab and pertuzumab) form a significant proportion of cardio-oncology patients undergoing echocardiography. This guideline from the British Society of Echocardiography and British Cardio-Oncology Society outlines a protocol for baseline and surveillance echocardiography of patients undergoing treatment with anthracyclines and/or trastuzumab. The methodology for acquisition of images and the advantages and disadvantages of techniques are discussed. Echocardiographic definitions for considering cancer therapeutics-related cardiac dysfunction are also presented.

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Section: Function Assessment By Echocardiographymentioning

confidence: 99%

British Society for Echocardiography and British Cardio-Oncology Society guideline for transthoracic echocardiographic assessment of adult cancer patients receiving anthracyclines and/or trastuzumab

Dobson¹,

Ghosh

et al. 2021

Echo Res Pract

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“…Although the peak global longitudinal and radial strain decreased, 10 patients demonstrated a reduction in lateral s' at 3 months after trastuzumab treatment, and these 10 patients all eventually developed trastuzumab-mediated cardiotoxicity. Retrospective studies have also shown that 20% of patients develop new or worsening diastolic dysfunction during breast cancer treatment ( 42 , 43 ). In the aforementioned studies, the diastolic dysfunction was evaluated by TDI indexes including mitral annular e'velocity (septal and lateral) and average E/e' ratio.…”

Section: Surveillance Strategiesmentioning

confidence: 99%

“…In the aforementioned studies, the diastolic dysfunction was evaluated by TDI indexes including mitral annular e'velocity (septal and lateral) and average E/e' ratio. Notably, a reduction in diastolic function was observed in patients treated with doxorubicin alone or doxorubicin followed by trastuzumab but not in those treated with trastuzumab alone ( 42 ). Early changes in diastolic function are closely associated with a subsequent reduction of ejection fraction.…”

Section: Surveillance Strategiesmentioning

confidence: 99%

Cardiotoxicity of anthracycline‑free targeted oncological therapies in HER2‑positive breast cancer (Review)

Guan

Zhang

2020

Oncol Lett

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Anthracycline drugs are considered to be pivotal drugs in numerous chemotherapy regimens for breast cancer. However, the cardiotoxicity associated with the treatment is an important issue to be addressed. With the emergence of increasingly diverse antitumor drugs, anthracycline-free therapies are able to reduce the cardiotoxicity caused by anthracycline drugs while ensuring that a therapeutic effect is achieved. In the present review, anthracycline-free oncological therapy regimens for the treatment of patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer and the associated cardiovascular toxicity are discussed, as well as some monitoring strategies. It is recommended that patients with HER2-positive breast cancer patients should receive adjuvant chemotherapy with single or dual-targeted therapy, with or without endocrine therapy according to the hormone receptor status determined by immunohistochemical examination. The main side effects of targeted therapy include cardiac dysfunction, hypertension and arrhythmia. According to individual risk stratification, it is recommended that patients should be periodically monitored using echocardiography, electrocardiography and serum markers, to enable the timely detection of the cardiovascular adverse reactions associated with tumor treatment, thereby preventing the morbidity and mortality caused by the cardiotoxicity of these drugs.

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“…9 In this cohort, we had previously defined both the changes in left ventricular systolic and diastolic function with exposure to cancer therapy, which are on the order of LVEF −6.6% (95% CI, −8.2, −5.0%), longitudinal strain 0.9% (95% CI, 0.3, 1.5%), E/e′ 0.8 (0.3, 1.4) for sequential doxorubicin and trastuzumab. 3,10 Here, we performed a detailed analysis of the changes in self-reported physical activity in a well-phenotyped cohort of 603 participants with breast cancer undergoing doxorubicin and/or trastuzumab therapy to determine: (a) changes in self-reported physical activity with cancer treatment; (b) baseline predictors of physical activity during and after cancer treatment; and (c) the associations between baseline self-reported physical activity and changes in echocardiography-derived parameters of systolic and diastolic function after cancer therapy. For the latter, we focused solely on baseline physical activity given concerns over reverse causation.…”

Section: Introductionmentioning

confidence: 99%

Physical activity during and after breast cancer therapy and associations of baseline physical activity with changes in cardiac function by echocardiography

Upshaw

Hubbard

et al. 2020

Cancer Medicine

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Background Observational studies suggest that regular physical activity may reduce cardiovascular morbidity and cancer recurrence in survivors of breast cancer. The association between physical activity and cardiac function with breast cancer therapy is unknown. Methods Self‐reported physical activity was assessed using the Godin Leisure‐Time Exercise Questionnaire at repeated intervals in a longitudinal cohort study of 603 breast cancer participants treated with doxorubicin and/or trastuzumab. Multivariable regression models estimated associations between clinical variables and physical activity. Generalized estimating equations adjusted for prespecified variables estimated associations between baseline physical activity and longitudinal echocardiographic measures of systolic and diastolic function. Results Physical activity was low at baseline, prior to cancer therapy initiation. More than half of participants reported no moderate‐strenuous physical activity, and only 12.1% met guideline recommended levels of physical activity. Physical activity increased after chemotherapy completion; however, only 26.0% of individuals were sufficiently active 3 years after cancer diagnosis. Body mass index, hyperlipidemia and higher cancer stage were significantly associated with lower total physical activity at baseline. Higher baseline physical activity was very modestly associated with an attenuation in the absolute decline in left ventricular ejection fraction over time (β 0.4%, 95% CI 0.1, 0.7, P = .02 for each 10‐unit increase in total activity). There tended to be a cardioprotective association with cardiotoxicity risk, although this was not statistically significant (HR 0.83, 95% CI 0.66, 1.04, P = .097). Conclusions A small proportion of breast cancer patients and survivors are engaged in regular moderate‐strenuous physical activity. While only modest associations between self‐reported physical activity and left ventricular systolic function were observed, our findings do not exclude a cardioprotective benefit of exercise.

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Comprehensive Assessment of Changes in Left Ventricular Diastolic Function With Contemporary Breast Cancer Therapy

Cited by 97 publications

References 31 publications

British Society for Echocardiography and British Cardio-Oncology Society guideline for transthoracic echocardiographic assessment of adult cancer patients receiving anthracyclines and/or trastuzumab

British Society for Echocardiography and British Cardio-Oncology Society guideline for transthoracic echocardiographic assessment of adult cancer patients receiving anthracyclines and/or trastuzumab

Cardiotoxicity of anthracycline‑free targeted oncological therapies in HER2‑positive breast cancer (Review)

Physical activity during and after breast cancer therapy and associations of baseline physical activity with changes in cardiac function by echocardiography

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