Left ventricular systolic dysfunction after trastuzumab therapy for breast cancer

Newer biologic therapies for breast cancer, such as trastuzumab, increase the risk of severe left ventricular systolic dysfunction (LVSD) and heart failure (HF). A recent combined NCI-NHLBI meeting on Cancer Treatment-related Cardiotoxicity held in March 2013 highlighted the need for clinical tools for identifying breast cancer patients at increased risk for LVSD for more frequent monitoring of cardiac function or receipt of potential preventative therapies. However, robust clinical risk models for predicting LVSD after breast cancer therapy do not currently exist; extrapolation from clinical trials is limited as these studies predominately enrolled subjects of younger age with few cardiac risk factors.
In addition, novel imaging techniques, such as echocardiographic strain— a measure of the compressibility of cardiac tissue—have been proposed as methods for providing early warning of impending LVSD from trastuzumab. However, studies of strain have examined small samples and were conducted in academic centers with particular expertise in advanced imaging. It is unclear whether echocardiograms performed in community practices would yield comparable strain data.
Accordingly, we propose this pilot project project to demonstrate that 1) electronic medical record data at CRN sites can accurately identify patients with LVSD after trastuzumab, and that 2) existing clinical echocardiograms acquired during routine trastuzumab monitoring can be successfully analyzed for calculation of strain. The results of this pilot will demonstrate feasibility and provide preliminary data for a larger multi-site CRN study using clinical and imaging data to develop a clinically useful risk score for predicting LVSD after trastuzumab. This project fits the interests of the CRN Scientific Working Group on Epidemiology of Prognosis and Outcomes.

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