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Delayed Trastuzumab-induced Cardiotoxicity Leading to Severe Left Ventricular Dysfunction.
Ikuo Misumi1, Reiki Nishimura2, Shota Nakamura3
1Department of Cardiology, Ueki Hospital, Japan.
Internal Medicine (Tokyo, Japan)
|October 20, 2024
Summary
This case study highlights delayed trastuzumab-induced myocardial injury in an elderly woman. Serial cardiac imaging revealed significant improvement in heart function after treatment cessation.
Area of Science:
- Cardiology
- Oncology
- Medical Imaging
Background:
- Trastuzumab is a targeted therapy used in cancer treatment.
- Cardiotoxicity is a known side effect of trastuzumab, often appearing early in treatment.
- Delayed-onset cardiotoxicity is less common but requires vigilant monitoring.
Purpose of the Study:
- To present a case of delayed trastuzumab-induced myocardial injury.
- To illustrate the utility of serial cardiac imaging in evaluating cardiac function and structure.
- To emphasize the importance of long-term cardiac monitoring in patients treated with trastuzumab.
Main Methods:
- A case report of an 81-year-old woman with dyspnea after nine years of trastuzumab therapy.
- Diagnostic imaging included chest radiography, transthoracic echocardiography, and cardiac magnetic resonance imaging (CMR).
- Serial echocardiography was performed to monitor left ventricular ejection fraction (LVEF) over time.
Main Results:
- Chest radiography showed pleural effusion.
- Transthoracic echocardiography revealed interventricular septum (IVS) dyskinesis.
- CMR indicated myocardial edema or fibrosis in the interventricular septum and apex.
- LVEF improved from 25% to 48% over six months following initial assessment.
Conclusions:
- Delayed trastuzumab-induced myocardial injury can occur years after treatment initiation.
- Serial transthoracic echocardiography and CMR are valuable tools for assessing cardiac structure and function in such cases.
- Long-term cardiac surveillance is crucial for patients receiving trastuzumab therapy.
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