Cardiotoxicity in patients on anthracyclines and traztuzumab: Identifying risk factors and echocardiographic parameters.

Abstract

e24052 Background: Anthracyclines and human epidermal growth factor receptor 2(HER-2) directed therapy are widely used as chemotherapy in various cancers. Up to 10% of patients treated with anthracyclines will develop reduction in left ventricle ejection fraction (LVEF), and cardiotoxicity by HER-2 directed therapy can be as high as 35%. The drop in EF is often late and changes may not be reversed at that point. Strain imaging using global longitudinal strain (GLS) has potential for detecting cardiotoxicity earlier however guidelines remain to be standardized. The objective of this study is to study variations in GLS over time as well as evaluate the relation of patient characteristics with various echocardiographic parameters. Methods: Linear mixed effects models with random intercepts were used to evaluate trends in EF and GLS over time and model the association of cancer therapy and patient characteristics with repeated measures of GLS and EF. Patients were enrolled in the study from 2018-2021 who received anthracycline, or HER-2 targeted treatment for any cancer and had serial echocardiography. Results: In the overall cohort there were more females (61%) than males (20%) in the study. Most patients had breast cancer (67%), followed by leukemia (14%) and lymphoma (13%).35% patients were in the younger age group (< 65 years) and 46% patients were in the older age (≥65 years). There was a significant change in GLS in older patients at 7-9 months (-15 SE 0.6) and 10-12 months (-14 SE 1) (P 0.006; P 0.001). Only 13 patients out of 81 patients developed cardiotoxicity as defined by the current consensus guidelines based on LVEF. Further analysis was then performed between these two groups at various time intervals. LV end diastolic volume (LVEDV) at baseline was significantly higher in the cardiotoxic group (P 0.016). GLS at baseline in both groups had no statistical difference. However, GLS began to show significant differences in the initial 1-3 months in the cardiotoxic group (-14; SE 0.9) as compared to the non-cardiotoxic group (-17.03; SE 0.3) (P 0.003). This difference persisted over various time points from 4 months till 1 year (P < 0.0001 at all points). Conclusions: Our data suggests that GLS may be used as a measure to identify patients who will develop cardiotoxicity by obtaining it at baseline and early during treatment. Higher baseline LVEDV was associated with development of cardiotoxicity. Older patients tend to have more drop in GLS and frequent measures will help to detect cardiotoxicity in this group.