Abstract 10408: What Is the Optimal Early Predictor of Subsequent Ejection Fraction Fall After Chemotherapy?
Background: The possibility of cardiotoxicity with trastuzumab mandates sequential LVEF assessment, but there is concern that awaiting EF change risks irreversible LV dysfunction (LVD). Various myocardial function indices (eg. strain [ε] and strain rate [SR]) may detect preclinical LVD before EF changes. We sought the optimal parameter for predicting decrease in EF.
Methods: Of 50 women (age; 52±14) receiving chemotherapy for breast cancer, 28 received anthracyline simultaneously with trastuzumab. Conventional echo indices (isovolumic relaxation time, mitral annular E’ velocity) and myocardial deformation indices (global longitudinal systolic ε and SR from speckle tracking and number of abnormal strain segments) were measured at 3 time points (baseline, 6 and 12 months).
Results: 13 patients (26%) showed >10% decrease in EF in 12 months. In these patients, conventional echo indices were unchanged at 6 months, but ε (-20±2 vs -17±3%, p=0.007) and SR (-1.6±0.6 vs -1.0±0.3/s, p=0.004) decreased. There were no 6 months changes in patients who had preserved EF at 12 months. Only ε and SR predicted 12 months EF. The area under the receiver operating characteristic (ROC) curve of SR was 0.87 (best cut-point -7.5%, sensitivity 91%, specificity 79%) and ε was 0.81 with -11.9% (sensitivity; 82%, specificity; 83%). The number of abnormal segments in 6 months did not predict decrease EF in 12 months. Logistic regression showed that ε (p=0.014; odds ratio 0.939 per unit change) and SR (p=0.002; 0.922) predicted decrease in EF independent of age, hypertension and diabetes mellitus.
Conclusions: Changes in average myocardial deformation independently predict chemotherapy-induced cardiotoxicity in breast cancer patients.
- © 2011 by American Heart Association, Inc.