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Rivista sulle Malattie del Cuore e dei Vasi

Official Journal of the Italian Society of Angiology and Vascular Pathology
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Minerva Cardioangiologica 2016 Nov 25

lingua: Inglese

Cardiac monitoring in patients on trastuzumab: correlation of ultrasound and radionuclide ventriculography

Erika MATOS 1, Borut JUG 2, Barbara VIDERGAR KRALJ 3, Branko ZAKOTNIK 1

1 Institute of Oncology Ljubljana, Department of Medical Oncology, Ljubljana, Slovenia; 2 University Medical Centre Ljubljana, Department of Vascular Diseases, Ljubljana, Slovenia; 3 Institute of Oncology Ljubljana, Department of Nuclear Medicine, Ljubljana, Slovenia


BACKGROUND: Guidance on cardiac surveillance during adjuvant trastuzumab therapy remains elusive. The recommended methods are 2-dimensional echocardiography (2D-ECHO) and electrocardiography gated equilibrium radionuclide ventriculography (RNV). We assessed the correlation and possible specific merits of these two methods.
METHODS: In a prospective cohort study in patients undergoing post-anthracycline adjuvant trastuzumab therapy, clinical assessment, 2D-ECHO and RNV were performed at baseline, 4, 8 and 12 months. The correlation between used methods was estimated with Pearson's correlation coefficient and Bland-Altman analysis.
RESULTS: 92 patients (mean age 53.6 ± 9.0 years) were included. The correlation of LVEF measured by ECHO and RNV at each time point was statistically insignificant. Values obtained by ECHO were on average higher (3.7% to 4.5%). A decline in LVEF of ≥ 10% from baseline was noticed in 19 (24.4%) and 13 (14.9%) patients with ECHO and RNV, respectively, however in only one patient by both methods simultaneously. A decline in LVEF of ≥ 10% to below 50% was found in three and none patients according to RNV and ECHO measurements, respectively.
CONCLUSIONS: There is a weak correlation of ECHO and RNV measurements in individual patient, the results obtained by the methods are not interchangeable. LVEF values determined by 2D- ECHO were on average higher compared to RNV determined ones. When in an asymptomatic patient a decline in LVEF requiring treatment interruption is detected by RNV ECHO re-evaluation and referral to a cardiologist is advised.

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