ECHO 2013 / Cancer Treatment Related Cardiotoxicity
.pdf
6 month Echo follow-up (after adriamycin
and several cycles of herceptin)
Baseline |
6 months |
|
EF 51% |
||
EF 64% |
||
|
||
Asymptomatic EF drop 13% |
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What to do? |
|
|
FDA Package Insert
“…Patients with an absolute decrease in LVEF ≥ 16% from pre-treatment values or
LVEF ≤ 50% and ≥ 10% absolute decrease should have trastuzumab held until repeated echocardiogram confirms LVEF recovery.”
Trastuzumab FDA package insert
6 month Echo follow-up (after adriamycin
and several cycles of herceptin)
Baseline |
6 months |
|
|
EF 64% |
EF 51% |
|
Asymptomatic EF drop 13% What to do?
EF by 3D Echo
6 month echo: EF 48%
2D Longitudinal Strain
GLS = -20.9% |
GLS = -13.9% |
|
6 months |
||
Baseline |
||
|
Case
•Given the change in EF and strain, trastuzumab was held and BB therapy intitated.
•Repeat echo 6 weeks later showed improvement in LVEF and strain and trastuzumab was restarted.
Take Home Message
•Use multiple methods to assess LV systolic function. Obtain 3D and strain, if possible.
•Accurate assessment is crucial
•Your patient’s life depends on it!
Cancer Treatment-Related Cardiotoxicity
Overview
•The Burden of Disease
•Chemotherapeutic related cardiotoxicity
•Monitoring and detection of cardiotoxicity
•Gaps in Knowledge
–Research questions
Gaps in Knowledge (1)
Q: What is the optimal global longitudinal strain cut-off value for the prediction of cardiotoxicity?
A: Need clinical trials to determine cut-off value before incorporating into clinical practice.
Gaps in Knowledge (2)
Q: Does early detection and treatment impact on clinical outcome?
A: Multicenter, randomized clinical trial to compare the incidence of HF by two strategies:
– Monitoring, adjudication of cardiotoxicity and treatment by conventional EF vs. strain.