Delayed contrast enhancement cardiac magnetic resonance imaging in trastuzumab induced cardiomyopathy

Between 2005–2006 inclusive, 160 breast cancer patients were identified at a single tertiary care oncology centre. Of the total population, 10 patients (mean age 40 ± 8 years) were identified with trastuzumab induced cardiomyopathy, based on a LVEF less than 40% on serial MUGA or echocardiography. CMR was performed in all patients to determine LV volumes, systolic function and evidence of late gadolinium enhancement (LGE). At the time of diagnosis of trastuzumab induced cardiomyopathy, the mean LVEF was 29 ± 4%. Subepicardial linear LGE was present in the lateral portion of the left ventricles in all 10 patients.LGE-CMR is a novel way of detecting early changes in the myocardium due to trastuzumab induced cardiotoxicity.Breast cancer is a major public health concern that affects 1 in 7 women in their lifetime [1]. Anthracyclines are commonly used in the setting of adjuvant therapy in the treatment of breast cancer patients. While anthracyclines significantly improve clinical morbidity and mortality, there are notable cardiotoxic side effects [2]. Recent understanding of the biology of breast cancer has lead to the introduction of a new therapeutic agent, Trastuzumab (Herceptin), an antagonist to the human epidermal growth factor 2 (HER2) receptor, which is found in 25% of breast cancer patients [3]. When added to conventional anthracycline chemotherapy, trastuzumab significantly decreases the rates of recurrence and mortality by 50% in HER-2 positive breast cancer patients [4-6]. Despite therapeutic benefits however, the risk of cardiotoxicity with trastuzumab ranges from 10–15% when administered in combination with anthracyline therapy [7,8].Serial multiple gated acquisition scans (MUGA) are widely used to monitor cardiac dysfunction in breast cancer patients. However, with the improvement in both spatial and temporal resolution of cardiac magnetic resonance (CMR) over the past decade, it has now become the gold standard for the non-invasive assessment of left vent