2D-echocardiography vs cardiac MRI strain using deep learning: a prospective cohort study in patients with HER2-positive breast cancer undergoing trastuzumab. (8th February 2021)

• Record Type: Journal Article
• Authors: Bouwer, NI; Liesting, C; Kofflard, MJM; Brugts, JJ; Kock, MCJ; Kitzen, JJEM; Levin, M-D; Boersma, E
• Is Part Of: European heart journal. Volume 22(2021)Supplement 1
• Publication Date: 2021-02-08
• Subjects: Cardiovascular system -- Imaging -- Periodicals; Heart -- Imaging -- Periodicals; 616.10754
• DOI: 10.1093/ehjci/jeaa356.118
• Languages: English
• ISSNs: 2047-2404

Abstract

Abstract: Funding Acknowledgements: Type of funding sources: Private hospital(s). Main funding source(s): Promotiefonds Albert Schweitzer Hospital Background: Subclinical cardiotoxicity due to trastuzumab could be recognized by repeated measurements of global longitudinal/radial strain (GLS/GRS) which could be performed with cardiac magnetic resonance (CMR) or two-dimensional speckle tracking echocardiography (2DE-ST). Although CMR is the gold standard for cardiac function evaluation, it is not used for cardiac monitoring. 2DE-ST might be a reasonable alternative. Purpose: To study the predictive value of early 2DE-ST for left ventricular ejection fraction (LVEF) changes during trastuzumab for HER2-positive breast cancer. Methods: HER2-positive breast cancer patients receiving trastuzumab, with or without anthracycline, underwent 2DE-ST at baseline and after 3 and 6 months (m) trastuzumab. Cardiac magnetic resonance (CMR) imaging (with ST) was performed at baseline and 6m. We studied the correlation between 2DE-ST- and CMR-derived GLS and GRS. We then associated baseline and 3m 2DE-ST with later CMR-LVEF, and with cardiotoxicity, defined as CMR-LVEF <45% and/or absolute decline >10% during trastuzumab. Results: 47 patients were included. GLS measurements based on 2DE-ST and CMR showed weak correlation (Pearson's r = 0.33; P = 0.041); GRS measurements were uncorrelated (r = 0.09; P = 0.979). 2DE-LVEF at baseline and 3m, and 2DE-STE-GLS at 3m were predictive of CMR-LVEF at 6m (Table 1). In contrast, the change in 2DE-ST-GLS at 3m was predictive of the change in CMR-LVEF at 6m, whereas the change in 2DE-LVEF was not. Importantly, the 11 patients (28%) who developed cardiotoxicity had larger 2DE-ST-GLS change at 3m than those who did not (median 5.2% versus 1.7%; odds ratio 1.81, 95% confidence interval 1.11–2.93; P = 0.016). Conclusion: Although correlations between 2DE-ST and CMR are weak, ST-measurements appeared useful to improve the performance of 2DE in predicting LVEF changes after 6m of trastuzumab.