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Echocardiographic signs of right ventricle changes after Trastuzumab treatment in breast cancer patients with erb-2 overexpression [Anatol J Cardiol]
Anatol J Cardiol. 2015; 15(2): 143-148 | DOI: 10.5152/akd.2014.5220  

Echocardiographic signs of right ventricle changes after Trastuzumab treatment in breast cancer patients with erb-2 overexpression

Barış Kılıçaslan1, Öner Özdoğan1, Gönül Demir Pişkin2, Nihan Kahya Eren3, Hüseyin Dursun1
1Clinic of Cardiology, Tepecik Research and Training Hospital; İzmir-Turkey
2Clinic of Oncology, Tepecik Research and Training Hospital; İzmir-Turkey
3Clinic of Cardiology, Atatürk Research and Training Hospital; İzmir-Turkey

Objective: Left ventricular (LV) dysfunction after trastuzumab treatment in erb-2 breast cancer cases has been fully investigated. However, there is not enough data about the effect of trastuzumab treatment on right ventricular (RV) functions. This study is designed to evaluate the right heart changes by performing echocardiography after trastuzumab treatment in patients with erb-2 breast cancer.
 
Methods: Forty-two consecutive breast cancer patients with erb-2 overexpression mean age 50.4±11.6 years who were decided to receive trastuzumab treatment were enrolled. Echocardiographic examinations including 2-D, spectral, and tissue Doppler measurements were performed at the baseline (T1) and repeated after 6 months (T2).
 
Results: Tricuspid annular plane systolic excursion (TAPSE) was decreased, RV myocardial performance index (RVMPI) and tricuspid E/e’ ratio was increased after trastuzumab treatment (1.84 vs. 2.14; p<0.01) (0.46 vs. 0.56, p<0.01) (4.4±1.07 vs. 5.08±1.46; p=0.04). Median serum NT-ProBNP levels, troponin I, and hs-CRP levels were similar between the groups. LVEF and TAPSE were negatively correlated with dosage of trastuzumab (r=-0.392, p=0.04; r=-0.522, p=0.006). There was a stepwise decrease in LVEF when trastuzumab used with anthracyclines however this not reached statically significant (62.4±2, 60±4.5; p=0.06).
 
Conclusion: In our study; we observed a trend of RV deterioration after trastuzumab treatment. These preliminary RV changes were demonstrated by using TAPSE, RV tissue Doppler imaging derived MPI and E/e’ ratio parameters by echocardiography and these parameters could also use as markers of trastuzumab toxicity in this population. 
 

Keywords: breast cancer, trastuzumab, tricuspid annular plane systolic excursion, right ventricle, myocardial performance index


Meme kanserli hastalarda Trastuzumab tedavisi sonrası sağ ventrikülün değerlendirilmesi

Barış Kılıçaslan1, Öner Özdoğan1, Gönül Demir Pişkin2, Nihan Kahya Eren3, Hüseyin Dursun1
1Clinic of Cardiology, Tepecik Research and Training Hospital; İzmir-Turkey
2Clinic of Oncology, Tepecik Research and Training Hospital; İzmir-Turkey
3Clinic of Cardiology, Atatürk Research and Training Hospital; İzmir-Turkey

Amaç: Erb-2 (+) meme kanserli hastalarda trastuzumab tedavisi sonrası sol ventrikül tutulumunun olabileceği bilinmektedir. Fakat sağ ventrikül tutulumuna dair yeterli bilgi birikimi yoktur. Bu çalışmanın amacı ekokardiyografik olarak erb-2 (+) meme kanserli hastalarda trastuzumab tedavisi sonrası sağ kalp tutulumunu araştırmaktır. 
 
Yöntemler: Erb-2 (+) meme kanseri sebebiyle trastuzumab tedavisi alan 42 hasta çalışmaya alındı. Tüm hastalara tedavi öncesi (T1) ve altıncı ayda (T2) konvansiyonel, 2-D ve doku Doppler ölçümlerini içeren standart ekokardiyografi tetkiki yapıldı.
 
Bulgular: Trastuzumab tedavisi sonrası triküspit anüler düzlem sistolik hareketleri (TAPSE) azalmış, sağ ventrikül miyokart performans indeksi (SVMPİ) ve triküspit E/e’ oranı artmştır (1,84' karşı 2,14; p<0,01) (0,46'ya karşı 0,56, p<0,01) (4,4±1,07'e karşı 5,08±1,46; p=0,04). Ortalama serum NT-ProBNP, troponin I ve hs-CRP düzeyleri benzer saptandı. Sol ventrikül ejeksiyon fraksiyonunda (LVEF) ve TAPSE trastuzumab dozu arasında negatif korelasyon saptandı (r=-0,392, p=0,04; r=-0,522, p=0,006). Trastuzumab antrasiklinler ile birlikte kullanıldığında LVEF azalma saptandı fakat bu istatiksel anlamlılığa ulaşamadı (62,4±2, 60±4,5; p=0,06).
 
Sonuç: Bizim çalışmamızda, trastuzumab tedavisi sonrası sağ ventrikül fonksiyonlarında bozulma eğilimi saptanmıştır. Bu öncül değişikliklerin saptandığı ekokardiyografik parametreler (TAPSE, SVMPI ve E/e’ oranı) bu grup hastalarda trastuzumab toksisitesini göstermek için kullanılabilirler.


Anahtar Kelimeler: meme kanseri, trastuzumab, triküspit anüler düzlem sistolik hareketleri (TAPSE), sağ ventrikül, miyokart performans indeksi.


Barış Kılıçaslan, Öner Özdoğan, Gönül Demir Pişkin, Nihan Kahya Eren, Hüseyin Dursun. Echocardiographic signs of right ventricle changes after Trastuzumab treatment in breast cancer patients with erb-2 overexpression. Anatol J Cardiol. 2015; 15(2): 143-148


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