Early Cardiac Remodeling in Women with Breast Cancer, Receiving Sequential Therapy with Anthracycline and Trastuzumab – Cardiac MRI Study

Background: Cardiotoxicity is an adverse prognostic marker in women with early-stage breast cancer. Understanding cardiac changes using cardiac-MRI will provide the opportunity to establish predictive models for early detection of cardiotoxicity. Methods: Eighty-three patients had cardiac MRI pre-anthracycline, within three weeks post-anthracycline, and at five months (~three months into trastuzumab therapy) on a 1.5T scanner; along with thirty volunteers scanned at matched time points. Results: Temporal and inter-observer test-retest variability, repeatability, and reproducibly of left and right ventricular volumetric parameters in healthy volunteers were statistically small. Ten patients (12.1%) developed LV-cardiotoxicity, 1 (10%) at 2 months and 9 (90%) at 5 months. LV-cardiotoxicity was associated with a significant increase in LVESV in 91% of the patients. Conclusions: Ventricular remodeling occurs during cancer therapy. The primary mechanism of cardiotoxicity is likely a reduction in contractility. Change in LVESV at 2 months is an early predictor of cardiotoxicity by 5 months.M.Sc