RT Journal Article
SR Electronic
T1 Persistent LV diastolic dysfunction abnormalities in breast cancer patients following chemotherapy.
JF Journal of Nuclear Medicine
JO J Nucl Med
FD Society of Nuclear Medicine
SP 518
OP 518
VO 58
IS supplement 1
A1 Ran Klein
A1 Doaa Nadouri
A1 Osler Erin
A1 Christopher Johnson
A1 Olexiy Aseyev
A1 Lionel Zuckier
A1 Susan Dent
A1 Girish Dwivedi
YR 2017
UL http://jnm.snmjournals.org/content/58/supplement_1/518.abstract
AB 518Objectives: Trastuzumab (T) and anthracycline based chemotherapy (CT) is considered standard of care in HER2+ overexpressing early stage breast cancer (ESBC). Due to known cardiotoxicity of these agents, left ventricular ejection fraction (LVEF) is monitored, with MUGA or echocardiograms, every 3-4 months during T treatment. Small studies suggest that diastolic dysfunction (DD) may be an earlier predictor of cardiotoxicity. In this preliminary, retrospective study we evaluated DD as an adjunct indicator for early detection of cardiotoxicity in ESBC treated at the Ottawa Hospital Cancer Center.Methods: ESBC patients treated with T +/- anthracycline based CT that had undergone MUGA were selected by date range (Jan 2006 - Sept 2015). Up to four scans were analyzed per patient: (1) before therapy (baseline), (2) post-anthracycline and prior to commencement of T therapy, (3) early into T therapy and (4) at end of T therapy. LV systolic and diastolic dysfunction were defined as follows: LVEF <50% or 10 points drop from baseline and LV peak filling rate (LVPFR) < 2.5 EDV/s and time to peak LV filling rates (LVTPFR) > 180 ms respectively.Results: 202 patients were screened for this study, of which 136 had anthracycline therapy (5.0±4.0 months duration) prior to T, 190 had 4 month follow-up data (4.0±2.2 months) and 151 beyond (10.6±4.9 months). LVEF decreased with anthracycline and T (p<0.005) therapy but remained stable between 4 month and final exam (p=0.2). LVPFR did not change significantly over the course of anthracycline therapy (p=0.1), but decreased over the course of T therapy (p<0.007). Using a previously described cutoff of 2.5 EDV/sec a significantly higher proportion of DD patients were identified at all time points compared to LVEF (25% vs 55%, p<0.0001 on pre-T and 33% vs. 67% on the final scans, p<0.0001). LVTPFR did not significantly change over the course of treatment (p>0.3).Conclusion: A significantly higher number of ESBC patients receiving T +/- anthracycline therapy demonstrate diastolic function abnormalities compared to LVEF. While previous, small studies indicate prevalence of DD in early stages of chemotherapy, our results suggest that the abnormalities persist during late phases following T therapy. Combining LVEF and LVPFR may increase sensitivity for detecting CT induced cardiotoxicity in ESBC. Further studies are warranted to evaluate the clinical implications of diastolic dysfunction in ESBC patients who have completed anthracycline and T based CT. Research Support: