Effect at One Year of Adjuvant Trastuzumab for HER2+ Breast Cancer Combined with Radiation or an Anthracycline on Left Ventricular Ejection Fraction.

To determine the impact of radiation therapy (XRT) in addition to trastuzumab (TZB) adjuvant chemotherapy for HER2+ breast cancer on left ventricular systolic function, we assessed demographics, oncologic treatment history including XRT exposure, and serial measurements of left ventricular ejection fraction (LVEF) in 135 consecutively identified women receiving TZB for treatment of adjuvant breast cancer. Longitudinal mixed effects models were fit to identify baseline to treatment changes in LVEF among those receiving TZB with or without concomitant anthracycline or XRT. Women averaged 53 ± 3 years in age, 77% were white, 62% patients had 1 or more cardiovascular risk factors at baseline, and mean duration of TZB was 11 ± 5 months. Seventy-seven women were treated with XRT and received between 4000 and 5500 cGy of radiation. The LVEF declined by an average of 3.4% after 1 year for those in the study. Relative to baseline upon completion of adjuvant TZB, LVEF remained reduced for those receiving anthracycline with or without XRT (p=0.002 for both), or XRT alone (p=0.002), but not in those without these therapies. Amongst patients treated only with XRT and TZB, LVEF declined 3.1% on average in those with left-sided disease and 6.9% on average in those with right-sided disease (p= 0.06, p= 0.008 respectively). Among women receiving TZB for adjuvant treatment of HER-2 positive breast cancer, the administration of XRT, anthracycline, or the combination of the 2 is associated with a persistent post-treatment as opposed to a temporary treatment related decline in LVEF.

Increased cardiovascular stiffness and impaired age-related functional status.

Our objective was to determine if increased cardiovascular (CV) stiffness is associated with disability in middle-aged and older adults at risk for congestive heart failure. CV stiffness (brachial pulse pressure/left ventricular stroke volume indexed to body surface area) and total disability (the summed assessment of activities of daily living, mobility, and instrumental activities of daily living) were measured in 445 individuals. A subset of 109 randomly selected individuals also underwent physical function testing. Total disability was associated with CV stiffness (p = .01), driven by an association with mobility (p = .005), but not activities of daily living (p = .13) or instrumental activities of daily living (p = .61). After accounting for age, these correlations remained significant for men (p = .04), but not for women. CV stiffness was also associated with increased 400-m walk time (p = .02). In middle-aged and elderly men at risk for congestive heart failure, CV stiffness is associated with decreased mobility and physical function, and increased overall disability.

Right ventricular morphology and systolic function in left ventricular noncompaction cardiomyopathy.

The distinction between normal right ventricular (RV) trabeculations from abnormal has been difficult. We evaluated whether RV volume and function are related to left ventricular (LV) noncompaction (NC) cardiomyopathy and clinical events. Trabeculations or possible LVNC by cardiac magnetic resonance imaging was retrospectively observed among 105 consecutive cases. We measured LV end-systolic (ES) noncompacted-to-compacted ratio, RV ejection fraction (EF), RV apical trabecular thickness, and RV end-diastolic (ED) noncompacted-to-compacted ratio. A control group of 40 subjects was also reviewed to assess the exploratory measures. Comparing those with LVES noncompacted-to-compacted ratio ≥2, those with LVES noncompacted-to-compacted ratio <2, and the normal control group, adjusted means for RV apical trabecular thickness and RVED noncompacted-to-compacted ratio were generated. Logistic regression was used to evaluate the association of composite events traditionally associated with LVNC with RVEF after adjustment for aforementioned covariates, cardiovascular risk factors, delayed enhancement, LVEF, and LVES noncompacted-to-compacted ratio. Analysis of RV morphology found greater apical trabecular thickness among those with LVES noncompacted-to-compacted ratio ≥2 compared with those with LVES noncompacted-to-compacted ratio <2 or normal control group (31 ± 5 vs 27 ± 2.6 vs 22 ± 4 mm; p = 0.03 and p = 0.003, respectively). There was no difference between the groups in relation to the RVED noncompacted-to-compacted ratio. Low RVEF and LVES noncompacted-to-compacted ratio ≥2 had significant association with clinical events in this population even after adjusting for clinical and imaging parameters (p = 0.04 and p <0.001, respectively). In conclusion, RV dysfunction in a morphologic LVNC population is strongly associated with adverse clinical events. LVNC is associated with increased trabeculations of the RV apex.

Comparison of systolic and diastolic criteria for isolated LV noncompaction in CMR.

OBJECTIVES: This study used cardiac magnetic resonance (CMR) to compare standard criteria for left ventricular noncompaction (LVNC). BACKGROUND: LVNC as a distinct cardiomyopathy is supported by a growing number of publications. Echocardiographic and CMR criteria have been established to diagnosis LVNC but have led to concerns of diagnostic accuracy. METHODS: Trabeculation/possible LVNC by CMR was retrospectively observed in 122 consecutive cases. We compared the standard end-systolic noncompacted-to-compacted ratio (ESNCCR), end-diastolic noncompacted:compacted ratio (EDNCCR), and trabecular mass-to-total mass ratio (TMTMR) along with deaths, embolic events, congestive heart failure (CHF) readmissions, ventricular arrhythmias, myocardial thickening (MT), left ventricular ejection fraction (LVEF), 3-dimensional sphericity index (3DSi), and left ventricular end-diastolic volume index. Adjusting for age, race, sex, body surface area, diabetes mellitus, hypertension, hyperlipidemia, coronary artery disease, and CHF, logistic regression was used to compare combined events (death, CHF readmission, embolism, ventricular arrhythmia) between ESNCCR, EDNCCR, and TMTMR. Adjusting for same covariates except CHF, logistic regression was used to compare the odds of CHF for those who met criteria and those who did not. Using analysis of covariance, adjusted means for LVEF, MT, 3DSi, and left ventricular end-diastolic volume index were generated. RESULTS: ES criteria had a higher odds ratio (8.6; 95% confidence interval [CI]: 2.5 to 33) for combined events than ED criteria (1.8; 95% CI: 0.6 to 5.8) or TMTMR criteria (3.14; 95% CI: 1.09 to 10.2). The odds ratio of CHF for those who met ESNCCR criteria was 29.4 (95% CI: 6.6 to 125), but the odds ratio of CHF for those who met EDNCCR criteria was 3.3 (95% CI: 1.1 to 9.2). After adjustment, those who met criteria for noncompaction by ESNCCR had a lower LVEF and less MT than those who did not (p = 0.01 and p = 0.003, respectively), but there was no difference between those who met criteria for EDNCCR or the TMTMR criteria and those who did not. CONCLUSIONS: ES measures of LVNC have stronger associations with events, CHF, and systolic dysfunction than other measures.