Predicting heart failure symptoms in breast cancer patients receiving Trastuzumab using cardiovascular magnetic resonance strain assessment

Abstract

Purpose: To assess the ability of global longitudinal strain (GLS) with cardiovascular magnetic resonance imaging (CMR) to detect cancer therapy-related cardiac dysfunction (CTRCD) and predict heart failure symptoms. Methods: Breast cancer patients who had undergone CMR for monitoring of left ventricular (LV) function while receiving Trastuzumab were retrospectively recruited. Baseline LV volumes and GLS before commencement of Trastuzumab were compared with follow-up scans at 3, 6, 9, and 12 months. CTRCD was determined using either the GLS criteria (defined as >5% absolute reduction or >12% relative reduction of GLS) or ejection fraction (EF) criteria (defined as >10% absolute reduction to <50% or >20% absolute reduction from baseline values). The primary outcome was patient reported heart failure symptoms within one year. Results: Thirty female breast cancer patients with a mean age of 64±10 years were recruited. Both GLS (20.2±3.1% vs 23.0±3.0%, p<0.001) and EF (61.9±5.7% vs 66.0±6.0%, p<0.001) declined at 3 months compared to baseline and remained low until 12 months. Nine participants (30%) developed heart failure symptoms within one year. More CTRCD was diagnosed using GLS compared to EF criteria (67% vs 10%, p<0.001). The sensitivity and specificity to predict HF symptoms at 1-year were 78% and 35% for GLS, and 11% and 91% for EF, respectively. Conclusion: Both GLS and EF declined as early as 3 months after receiving Trastuzumab. GLS has greater sensitivity than EF to predict heart failure symptoms at 1-year. GLS assessment in cardiac CMR surveillance during chemotherapy may provide earlier detection of subclinical heart failure than using EF alone.