ORIGINAL ARTICLE   

Minerva Cardioangiologica 2017 June;65(3):288-98

DOI: 10.23736/S0026-4725.16.04201-8

Copyright © 2016 EDIZIONI MINERVA MEDICA

language: English

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

BACKGROUND: Guidance on cardiac surveillance during adjuvant trastuzumab therapy remains elusive. The recommended methods are two-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: Ninety-two 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.

KEY WORDS: Breast neoplasms - Trastuzumab - Cardiotoxicity - Echocardiography - Radionuclide ventriculography - Cardiac-gated imaging techniques