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Left atrial volume in patients with HER2-positive breast cancer: One step further to predict trastuzumab-related cardiotoxicity.

Left atrial volume in patients with HER2-positive breast cancer: One step further to predict trastuzumab-related cardiotoxicity.
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Bergamini C, Dolci G, Rossi A, Torelli F, Ghiselli L, Trevisani L, Vinco G, Truong S, La Russa F, Golia G, Molino A, Benfari G, Ribichini FL,


Bergamini C, Dolci G, Rossi A, Torelli F, Ghiselli L, Trevisani L, Vinco G, Truong S, La Russa F, Golia G, Molino A, Benfari G, Ribichini FL, (click to view)

Bergamini C, Dolci G, Rossi A, Torelli F, Ghiselli L, Trevisani L, Vinco G, Truong S, La Russa F, Golia G, Molino A, Benfari G, Ribichini FL,

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Clinical cardiology 2018 03 22() doi 10.1002/clc.22872
Abstract
BACKGROUND
Trastuzumab (TZ) therapy requires careful monitoring of left ventricular (LV) ejection fraction (LVEF) because it can be potentially cardiotoxic. However, LVEF is an imperfect parameter and there is a need to find other variables to predict cardiac dysfunction early. Left atrium (LA) enlargement has proven to be a powerful predictor of adverse outcomes in several disease entities.

HYPOTHESIS
Baseline LA volume enlargement might predict TZ-related LV dysfunction.

METHODS
HER2-positive breast cancer patients receiving TZ and undergoing transthoracic echocardiography at baseline and at follow-up every 3 months were retrospectively recruited. One-hundred sixty-two patients formed the study population.

RESULTS
Baseline LAVI was dilated in 14 patients (8.6%). Mean follow-up was 14 ± 4 months. Cardiotoxicity occurred in 24 patients (14.8%). LAVI was an independent predictor of TZ-induced LV dysfunction in a clinical model, after adjustment for age and hypertension (odds ratio per 5-mL/mLAVI increase: 1.34, 95% confidence interval: 1.03-1.82, P = 0.03); and in a hemodynamic model, including ventricular sizes and systolic blood pressure level (odds ratio per 5-mL/mLAVI increase: 1.34, 95% confidence interval: 1.01-1.81, P = 0.04). The predicted probability of developing cardiotoxicity increased progressively, in parallel with LAVI values.

CONCLUSIONS
Baseline LA dilatation emerges as a condition associated with the development of cardiotoxicity in HER2-positive breast cancer patients treated with TZ.

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