Trastuzumab-Induced Cardiomyopathy and Intermittent Left Bundle Branch Block

Tahir, Hassan; Bardia, Nikky; Bath, Kulwant; Ahmed, Yasir; Rafique, Muhammad; Omar, Bassam; Malozzi, Christopher

doi:10.14740/cr888

Cited by 7 publications

(4 citation statements)

References 17 publications

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“…New onset LBBB has not been commonly reported in chemotherapy‐related cardiac dysfunction. While 44% of patients with CHIC and LBBB in our study had progression from non‐specific intraventricular conduction delay to LBBB after being exposed to chemotherapy, only a few cases in the literature have described new onset LBBB with cancer‐directed therapy, particularly with trastuzumab and rituximab 5–8 …”

Section: Discussionmentioning

confidence: 57%

Outcomes of cardiac resynchronization therapy in patients with chemotherapy‐induced cardiomyopathy

Ezzeddine

Saliba

Jain

et al. 2021

Pacing Clinical Electrophis

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Background Several chemotherapy agents are associated with the development of non‐ischemic cardiomyopathy (NIC). When chemotherapy‐induced cardiomyopathy (CHIC) is associated with left bundle branch block (LBBB) and a left ventricular ejection fraction (LVEF) 35% or lower, cardiac resynchronization therapy (CRT) is often utilized to improve cardiac function and relieve symptoms. Objective To determine the echocardiographic and clinical outcomes of CRT in patients with CHIC. Methods The study included 29 patients with CHIC (CHIC group) and 58 patients with other types of NIC (control group) who underwent CRT implantation between 2004 and 2017. The primary endpoints were changes in LVEF, left ventricular end‐systolic diameter (LVESD), and left ventricular end‐diastolic diameter (LVEDD) at 6–18 months after CRT. The secondary outcomes included changes in left ventricular global longitudinal strain (GLS), systolic strain rate (SRS), early diastolic strain rate (SRE), and overall survival. Results Out of 29 patients with CHIC, 62.1% received chemotherapy for lymphoma, 13.7% for breast cancer, and 24.1% for sarcoma. The agent implicated in 93.1% of the patients was an anthracycline. Half of the patients had LBBB. The mean baseline LVEF was 28% ± 8%. The mean baseline QRS duration was 146 ± 26 ms. Twenty‐eight patients had post‐CRT follow‐up data. CRT was associated with improvement in echocardiographic outcomes in the CHIC group and the control group. There was no difference in overall survival between the two groups (log‐rank p = .148). Conclusion CRT improves left ventricular function and reverses remodeling in patients with CHIC.

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Section: Discussionmentioning

confidence: 57%

Outcomes of cardiac resynchronization therapy in patients with chemotherapy‐induced cardiomyopathy

Ezzeddine

Saliba

Jain

et al. 2021

Pacing Clinical Electrophis

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“…In a larger study including 68,113 BC patients, the chemotherapy group was shown to have higher Af incidence, while in the subgroup analysis, there were no significant differences regarding trastuzumab use [29]. Other abnormal electrocardiogram findings, including branch bundle blocks, QT prolonged, ventricular bigeminy, and non-sustained ventricular tachycardia in HER2-expressed BC patients, were shown as case reports [30][31][32]. A small cohort of 20 metastatic HER2 BC patients reported no arrhythmias after trastuzumab infusion [33].…”

Section: Chang Et Al Revealed Trastuzumab-induced Risk Of Maccementioning

confidence: 96%

The association of trastuzumab with atrial fibrillation and heart failure in breast cancer patients in routine clinical practice: a population-based propensity score matching and competing risk model analysis

Huang

Tsai

et al. 2022

Breast Cancer Res Treat

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Purpose Trastuzumab, a potent anti-human epidermal growth factor receptor 2 (HER2) monoclonal antibody, is conditionally reimbursed by the Taiwan National Health Insurance (NHI) for HER2-positive breast cancer (BC). Trastuzumab-induced cardiotoxicity studies have well characterized heart failure (HF) but fewer addressed arrhythmia, particularly the association of potential life threatening atrial fibrillation (Af) is poorly characterized. We aimed to study the trastuzumab-related risk of Af and HF using the claimed data of Taiwan NHI. Methods A nationwide retrospective cohort of patients with BC from the Taiwan NHI reimbursement database from January 2007 to December 2016 was analyzed. Propensity score matching and competing risk model analysis were used for adjusting confounding concurrent medication or comorbidities and competing events. The HF study was used to validate the method used. Results For Af, 12,472 trastuzumab users were matched with 12,472 non-trastuzumab users. For HF, 12,241 trastuzumab users and 12,241 non-users were enrolled. We found that trastuzumab users had significantly worse HF-free survival but not Af-free survival than non-trastuzumab users. In the competing risk analysis, the use of trastuzumab did not increase the risk of Af (hazard ratio [HR] 0.76, P = 0.0006) but was associated with HF (HR 1.19, P = 0.0052). The risk trends among stratifications by comorbidities and concurrent medication remained in similar directions for both Af and HF. Conclusion Trastuzumab in real-world practice was associated with an increased risk of HF, but was not associated with an increased risk of Af in BC patients. Trastuzumab-induced arrhythmogenic effects may be masked by concurrent heart-protecting measures, more prominent roles of comorbidities or concurrent medications under real-world settings. Further studies are required.

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“…In a larger study including 68113 BC patients, the chemotherapy group was shown to have higher Af incidence, while in the subgroup analysis, there were no signi cant differences regarding trastuzumabuse [40]. Other abnormal electrocardiogram ndings, including branch bundle blocks, QT prolonged, ventricular bigeminy, and non-sustained ventricular tachycardia in HER2 expressed BC patients, were shown as case reports [41][42][43]. A small cohort of 20 metastatic HER2 BC patients reported no arrhythmias after trastuzumab infusion [44].…”

Section: Grazette Et Al Showed Mitochondrial Dysfunction In Rat Myocy...mentioning

confidence: 94%

The Association of Trastuzumab with Atrial Fibrillation and Heart Failure in Breast Cancer Patients in Routine Clinical Practice: A Population Based Propensity Score Matching and Competing Risk Model Analysis

Huang

Tsai

et al. 2022

Preprint

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Purpose Trastuzumab, a potent anti-human epidermal growth factor receptor 2 (HER2) monoclonal antibody, is conditionally reimbursed by the Taiwan National Health Insurance (NHI) for HER2-positive breast cancer. Trastuzumab-induced cardiotoxicity studies have well characterized heart failure but fewer addressed arrhythmia, particularly the association of potential life threatening atrial fibrillation (Af) is poorly characterized. We aimed to study the trastuzumab-related risk of Af and HF by using the claimed data of Taiwan NHI. Methods A nationwide retrospective cohort of patients with BC from the Taiwan NHI reimbursement database from January 2007 to December 2016 was analyzed. Propensity score matching and competing risk model analysis were used for adjusting confounding concurrent medication or comorbidities and competing events. The HF study was used to validate the method used. Results For Af, 12,472 trastuzumab users were matched with 12,472 non-trastuzumab users. For HF, 12,241 trastuzumab users and 12,241 non-users were enrolled. We found that trastuzumab users had significantly worse HF-free survival but not Af-free survival than non-trastuzumab users. In the competing risk analysis, the use of trastuzumab did not increase the risk of Af (hazard ratio [HR] 0.76, P = 0.0006) but was associated with HF (HR 1.19, P = 0.0052). The risk trends among stratifications by comorbidities and concurrent medication remained in similar directions for both Af and HF. Conclusion Trastuzumab in real-world practice was not associated with an increased risk of Af in BC patients. However, its arrhythmogenic effects may be masked by more prominent roles of comorbidities or concurrent medications. Further studies are required.

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Trastuzumab-Induced Cardiomyopathy and Intermittent Left Bundle Branch Block

Cited by 7 publications

References 17 publications

Outcomes of cardiac resynchronization therapy in patients with chemotherapy‐induced cardiomyopathy

Outcomes of cardiac resynchronization therapy in patients with chemotherapy‐induced cardiomyopathy

The association of trastuzumab with atrial fibrillation and heart failure in breast cancer patients in routine clinical practice: a population-based propensity score matching and competing risk model analysis

The Association of Trastuzumab with Atrial Fibrillation and Heart Failure in Breast Cancer Patients in Routine Clinical Practice: A Population Based Propensity Score Matching and Competing Risk Model Analysis

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