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Title of Journal: Int J Cardiovasc Imaging

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Abbravation: The International Journal of Cardiovascular Imaging

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Springer Netherlands

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10.1016/0041-0101(92)90872-3

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1573-0743

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Timing of the negative effects of trastuzumab on c

Authors: Christian Cadeddu Alessandra Piras Mariele Dessì Clelia Madeddu Giovanni Mantovani Mario Scartozzi Andreas Hagendorff Paolo Colonna Giuseppe Mercuro
Publish Date: 2016/10/01
Volume: 33, Issue: 2, Pages: 197-207
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Abstract

Trastuzumab TZB has been shown to be extremely effective in breast cancer patients overexpressing HER2 but careful cardiac monitoring is required when TZB is administered with anthracyclines since the combination can increase its toxicity Myocardial deformation indexes associated with speckle tracking echocardiography STE have proven to be very sensitive in identifying early myocardial dysfunction An observational prospective study was designed to assess TZBinduced cardiac damage using STE in patients with HER2 positive breast cancer who had been sequentially treated with TZB following epirubicin EPI Conventional echocardiographic parameters and STE deformation indexes longitudinal radial and circumferential strain/strain rate and apical rotation were analyzed at baseline after each EPI treatment and 1 week after every other dose of TZB administration until 1 year follow up in order to focus on the timing and extent of myocardial impairment In the fortyfive enrolled patients a reduction in subendocardial function after EPI treatment was observed by a significant impairment of the global longitudinal strain/strain rate GLS/SR while a significant increase in the activity of the subepicardial fibers was highlighted by an increase in apical rotation After the second TZB dose a sudden reduction of the apical rotation was seen together with circumferential and radial strain/SR Most importantly the extent to which the apical rotation increased and decreased was found to strictly correlate with the GLS reduction at follow up We found that after EPI therapy subendocardial function was impaired even while a compensatory increase in apical rotation occurred Following TZB treatment we observed impairment in apical rotation which seems to be the first sign of global LV dysfunction predicting GLS reduction found at the end of treatment

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