Cardiotoxicity in low-to-moderate cardiovascular risk patients undergoing anti-HER2 therapy: A prospective CMR study

Abstract

Purpose

The study aims to investigate cardiotoxicity among individuals undergoing anti-HER2 therapy with a low-to-moderate risk of cardiovascular complications. Cardiac magnetic resonance (CMR) imaging will be employed in the investigation.

Methods

HER2-positive breast cancer patients who underwent CMR examinations both before and during therapy (first follow-up: 3-5 months; second follow-up: 6-12 months) between January 2021 and December 2022 were prospectively included. Each patient was evaluated for the risk of cardiovascular toxicity.

Results

Thirty-five HER2-positive breast cancer patients were included (48.86 ± 10.34 years). Eighty-nine percent of patients had low cardiovascular toxicity risk, and 11% had moderate cardiovascular toxicity risk. At follow-up CMR, nine (25.71%) patients developed cardiac dysfunction. At follow-up 1, there was a notable decrease in left ventricular ejection fraction, stroke volume index, cardiac output index, and absolute strain values, accompanied by higher T1 and T2 values as well as end-systolic volume index compared to baseline (p≤0.002). At follow-up 2, the T1 and T2 values recovered to near baseline. The cardiac output index exhibited a continuous decline (p=0.022), while other variables were similar (p>0.05). Furthermore, at follow-up 1, the T1 value displayed a marked increase in patients with 1-3 points in cardiovascular toxicity risk factors compared to those with no risk factors (p≤0.043).

Conclusions

It is common for patients with low-to-moderate cardiovascular risk to experience early cardiotoxicity during anti-HER2 therapy. T1 mapping is a valuable approach for quantifying the specific extent of subtle tissue damage.

Keywords

Breast cancer; Cardiotoxicity; Cardiac magnetic resonance imaging; HER2; T1 mapping