Have a personal or library account? Click to login
Cardiotoxicity in low-to-moderate cardiovascular risk patients undergoing anti-HER2 therapy: a prospective cardiac magnetic resonance study Cover

Cardiotoxicity in low-to-moderate cardiovascular risk patients undergoing anti-HER2 therapy: a prospective cardiac magnetic resonance study

Radiology and Oncology
Volume 59 (2025): Issue 4 (December 2025)
By: Sainan Cheng,  Mei Deng,  Linlin Qi,  Fenglan Li,  Jiaqi Chen,  Shulei Cui,  Yawen Wang,  Jianing Liu,  Yang Fan,  Lizhi Xie and  Jianwei Wang  
Open Access
|Oct 2025

Figures & Tables

FIGURE 1.

Study flow diagram. HER2 = human epidermal growth factor receptor 2
Study flow diagram. HER2 = human epidermal growth factor receptor 2

FIGURE 2.

CMR imaging in a 44-year-old woman with human epidermal growth factor receptor 2 (HER2)-positive right-side breast cancer. The top row images (A, B, C, D) represent the baseline. The middle row images (E, F, G, H) correspond to the condition after 4 cycles of the TCbHP regimen (104 days after the baseline scan). The bottom row images (I, J, K, L) show the status after 9 cycles of the TCbHP regimen (203 days after the baseline scan). In the axial breast enhancement scan images (A, E, I), a decrease in the tumour size of the right breast is observed (arrow). The diastolic phase images of left ventricular two-chamber plane (B, F, J) demonstrate a slight increase in left ventricular systolic volume. T1 mapping images (C, G, I) reveal an increase in T1 value in the septum of the mid short-axis slice during follow-up 1, followed by a decrease during follow-up 2. The global radial, circumferential and longitudinal strain (GRS, GCS and GLS) curves before and after TCbHP treatment are presented (D, H, L). CMR = cardiac magnetic resonance; GCS = global circumferential strain; GLS = global longitudinal strain; GRS = global radial strain; HER2 = human epidermal growth factor receptor 2; TCbHP = taxane plus carboplatin plus trastuzumab plus pertuzumab
CMR imaging in a 44-year-old woman with human epidermal growth factor receptor 2 (HER2)-positive right-side breast cancer. The top row images (A, B, C, D) represent the baseline. The middle row images (E, F, G, H) correspond to the condition after 4 cycles of the TCbHP regimen (104 days after the baseline scan). The bottom row images (I, J, K, L) show the status after 9 cycles of the TCbHP regimen (203 days after the baseline scan). In the axial breast enhancement scan images (A, E, I), a decrease in the tumour size of the right breast is observed (arrow). The diastolic phase images of left ventricular two-chamber plane (B, F, J) demonstrate a slight increase in left ventricular systolic volume. T1 mapping images (C, G, I) reveal an increase in T1 value in the septum of the mid short-axis slice during follow-up 1, followed by a decrease during follow-up 2. The global radial, circumferential and longitudinal strain (GRS, GCS and GLS) curves before and after TCbHP treatment are presented (D, H, L). CMR = cardiac magnetic resonance; GCS = global circumferential strain; GLS = global longitudinal strain; GRS = global radial strain; HER2 = human epidermal growth factor receptor 2; TCbHP = taxane plus carboplatin plus trastuzumab plus pertuzumab

FIGURE 3.

CMR imaging in a 68-year-old woman with HER2-positive right-side breast cancer. The upper images (A, B, C, D) depict the baseline condition. The lower images (E, F, G, H) represent the status after 4 cycles of the TCbHP regimen (106 days following the baseline scan). Axial breast enhancement scan images (A, E) exhibit a reduction in the tumour size of the right breast. Short-axis cine images reveal an enlargement in the left ventricular diastolic diameter (B, F). T1 mapping images (C, G) reveal an increase in T1 value in the septum of the mid short-axis slice during the follow-up. Strain curves demonstrate a reduction in the absolute values of global radial, circumferential and longitudinal strain (GRS, GCS and GLS) before and after treatment (D, H). CMR = cardiac magnetic resonance; GCS = global circumferential strain; GLS = global longitudinal strain; GRS = global radial strain; HER2 = human epidermal growth factor receptor 2; TCbHP = taxane plus carboplatin plus trastuzumab plus pertuzumab
CMR imaging in a 68-year-old woman with HER2-positive right-side breast cancer. The upper images (A, B, C, D) depict the baseline condition. The lower images (E, F, G, H) represent the status after 4 cycles of the TCbHP regimen (106 days following the baseline scan). Axial breast enhancement scan images (A, E) exhibit a reduction in the tumour size of the right breast. Short-axis cine images reveal an enlargement in the left ventricular diastolic diameter (B, F). T1 mapping images (C, G) reveal an increase in T1 value in the septum of the mid short-axis slice during the follow-up. Strain curves demonstrate a reduction in the absolute values of global radial, circumferential and longitudinal strain (GRS, GCS and GLS) before and after treatment (D, H). CMR = cardiac magnetic resonance; GCS = global circumferential strain; GLS = global longitudinal strain; GRS = global radial strain; HER2 = human epidermal growth factor receptor 2; TCbHP = taxane plus carboplatin plus trastuzumab plus pertuzumab

FIGURE 4.

Box plot show changes in cardiac magnetic resonance (CMR) variables between the baseline and follow-up CMR examinations. The results of CMR variables at baseline (n = 35), follow-up 1 (n = 32) and follow-up 2 (n = 16) were shown in blue, yellow and red box plot. Left ventricular ejection fraction (LVEF) decreased significantly at follow-up 1 and follow-up 2. T1 and T2 value increased significantly at follow-up 1, but recovered to a level not significantly different from the baseline. Global longitudinal strain (GLS), global radial strain (GRS) and global circumferential strain (GCS) decreased significantly at follow-up 1 and follow-up 2.
Box plot show changes in cardiac magnetic resonance (CMR) variables between the baseline and follow-up CMR examinations. The results of CMR variables at baseline (n = 35), follow-up 1 (n = 32) and follow-up 2 (n = 16) were shown in blue, yellow and red box plot. Left ventricular ejection fraction (LVEF) decreased significantly at follow-up 1 and follow-up 2. T1 and T2 value increased significantly at follow-up 1, but recovered to a level not significantly different from the baseline. Global longitudinal strain (GLS), global radial strain (GRS) and global circumferential strain (GCS) decreased significantly at follow-up 1 and follow-up 2.

FIGURE 5.

The comparison of T1 value between the baseline and follow-up cardiac magnetic resonance (CMR) examinations. Bars represent median T1 value. Blue dots represent human epidermal growth factor receptor 2 (HER2)-positive breast cancer patients with no cardiovascular toxicity risk factor and orange dots represent patients with 1–3 risk factors.
The comparison of T1 value between the baseline and follow-up cardiac magnetic resonance (CMR) examinations. Bars represent median T1 value. Blue dots represent human epidermal growth factor receptor 2 (HER2)-positive breast cancer patients with no cardiovascular toxicity risk factor and orange dots represent patients with 1–3 risk factors.

Clinical characteristics and treatment of the study participants

VariableValue
No. of participants35
Age, years*48.86 ± 10.34
Height (cm)*160.97 ± 4.20
Weight (kg)*62.61 ± 8.36
Body surface area (m2)*1.63 ± 0.12
Hypertension†5 (14%)
Chronic kidney disease0
Current smoker or significant smoking history0
Obesity (BMI > 30 kg/m2) †4 (11%)
Age 65–79 years†2 (6%)
Diabetes0
Hyperlipidaemia0
Prior cardiovascular disease0
HFA-ICOS baseline cardiovascular toxicity risk stratification†
Moderate risk (moderate risk factors with a total of 2–3 points)4 (11%)
Low risk31 (89%)
No risk factor18 (52%)
One moderate risk factor with a total of 1 point13 (37%)
Therapies†
HER2-targeted therapies without anthracycline25 (71%)
Trastuzumab8 (23%)
Trastuzumab and pertuzumab17 (48%)
Anthracycline chemotherapy followed by a taxane plus trastuzumab plus pertuzumab10 (29%)

Differences in CMR parameters at follow-up 1 between patients with and without baseline risk factors

VariablePatients with no risk factor (n = 16)Patients with 1-3 risk factors (n = 16)P Value
LV ejection fraction (%)57.92 ± 3.4356.75 ± 6.790.543
LV end-diastolic volume index (mL/m2)63.88 ± 10.8967.39 ± 14.920.454
LV end-systolic volume index (mL/m2)26.89 ± 5.6629.63 ± 11.700.406
LV mass index (g/m2)37.07 ± 6.6843.03 ± 8.860.040
Stroke volume index (mL/m2)36.60 ± 6.6737.61 ± 6.360.665
Cardiac output index (L/min×m2)2.84 ± 0.482.99 ± 0.490.387
Global radial strain30.56 ± 5.4027.07 ± 6.940.123
Global circumferential strain-17.94 ± 2.16-16.82 ± 2.370.174
Global longitudinal strain-15.11 ± 1.85-15.06 ± 1.900.938
T1 value (msec)1235.06 ± 36.771276.56 ± 44.250.007
T2 value (msec)48.95 ± 2.2849.94 ± 3.070.318
Heart rate during MR scan (bpm)77.56 ± 11.2881.38 ± 15.370.430

Cardiac magnetic resonance (CMR) parameter results between follow-up 1 and follow-up 2 (n = 13)

VariableFollow-up 1Follow-up 2P Value
LV ejection fraction (%)58.45 ± 4.4457.76 ± 5.530.545
LV end-diastolic volume index (mL/m2)66.33 ± 11.1362.32 ± 14.020.055
LV end-systolic volume index (mL/m2)27.59 ± 6.2026.35 ± 7.460.294
LV mass index (g/m2)38.07 (36.22, 44.09)39.13 (35.77, 43.31)0.650
Stroke volume index (mL/m2)39.37 (35.27, 43.55)39.44 (27.44, 40.83)0.101
Cardiac output index (L/min×m2)3.01 ± 0.472.60 ± 0.540.022
Global radial strain28.69 ± 8.1229.70 ± 6.480.670
Global circumferential strain-17.70 ± 2.52-17.12 ± 2.300.172
Global longitudinal strain-15.01 ± 1.46-14.74 ±1.700.647
T1 value (msec)1245.31 ± 22.461236.77 ± 40.360.486
T2 value (msec)49.67 ± 2.1949.11 ± 2.120.465
Heart rate during MR scan (bpm)78.38 ± 14.6773.92 ± 13.090.189

CMR parameter results between patients treated with anthracycline-based and non-anthracycline-based antihuman epidermal growth factor receptor 2 (HER2) therapies at follow-up 1

VariableAnthracycline-based therapy (n = 10)Non-anthracycline-based therapy (n = 22)P Value
LV ejection fraction (%)57.01 ± 3.6857.49 ± 5.990.816
LV end-diastolic volume index (mL/m2)67.51 ± 12.8364.78 ± 13.240.590
LV end-systolic volume index (mL/m2)28.88 ± 6.0127.98 ± 10.380.800
LV mass index (g/m2)41.76 ± 7.9139.28 ± 8.530.442
Stroke volume index (mL/m2)38.58 ± 7.7836.43 ± 5.800.389
Cardiac output index (L/min×m2)3.13 ± 0.492.82 ± 0.460.094
Global radial strain26.73 ± 6.6229.76 ± 6.160.218
Global circumferential strain-17.09 ± 1.92-17.52 ± 2.490.637
Global longitudinal strain-15.36 (-16.56, -13.74)-15.07 ± 2.051.000
T1 value (msec)1280.90 ± 43.101244.41 ± 42.290.032
T2 value (msec)49.65 (47.06, 53.10)49.04 ± 2.230.231
Heart rate during MR scan (bpm)84.20 ± 18.4477.32 ± 10.200.182

Cardiac magnetic resonance (CMR) parameter results at baseline and follow-up

VariableFollow-up 1 (n = 32)Follow-up 2 (n = 16)
Baseline 1Follow-up 1P ValueBaseline 2Follow-up 2P Value
LV ejection fraction (%)64.03 ± 4.1657.34 ± 5.32< 0.00166.23 ± 4.1957.45 ± 5.54< 0.001
LV end-diastolic volume index (mL/m2)68.23 ± 12.4165.63 ± 12.97> 0.05768.20 ± 11.5664.94 ± 14.010.275
LV end-systolic volume index (mL/m2)24.53 ± 6.1728.26 ± 9.150.00122.91 ± 5.0227.70 ± 7.600.002
LV mass index (g/m2)37.17 (33.96, 43.69)38.24 (34.40, 41.45)0.36939.23 ± 6.3140.03 ± 6.780.261
Stroke volume index (mL/m2)43.36 ± 8.1237.10 ± 6.43< 0.00144.84 ± 8.1239.46 (30.13, 42.17)0.002
Cardiac output index (L/min×m2)3.23 ± 0.582.91 ± 0.490.0023.19 ± 0.382.65 ± 0.510.001
Global radial strain33.59 ± 7.3128.81 ± 6.370.00137.16 ± 8.9930.07 ± 6.18< 0.001
Global circumferential strain-18.86 ± 2.41-17.38 ± 2.31< 0.001-19.93 ± 2.81-17.23 ± 2.34< 0.001
Global longitudinal strain-16.12 ± 1.55-15.09 ±1.850.001-16.67 ± 1.28-14.88 ± 1.600.004
T1 value (msec)1231.16 46.491255.81 ± 45.230.0011222.00 ± 40.891237.13 ± 35.190.051
T2 value (msec)47.86 ± 2.1749.43 ± 2.710.00148.13 ± 2.1548.84 ± 1.750.306
Heart rate during MR scan (bpm)74.50 ± 11.1179.47 ± 13.400.04872.50 ± 9.6872.69 ± 12.280.928
DOI: https://doi.org/10.2478/raon-2025-0043 | Journal eISSN: 1581-3207 | Journal ISSN: 1318-2099
Journal RSS Feed
Language: English
Page range: 510 - 521
Submitted on: Mar 16, 2025
|
Accepted on: May 23, 2025
|
Published on: Oct 27, 2025
Published by: Association of Radiology and Oncology
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year
Keywords:
breast cancer,
cardiotoxicity,
cardiac magnetic resonance imaging,
HER2,
T1 mapping
Related subjects:
Medicine,
Clinical medicine,
Internal medicine,
Haematology, oncology,
Radiology

© 2025 Sainan Cheng, Mei Deng, Linlin Qi, Fenglan Li, Jiaqi Chen, Shulei Cui, Yawen Wang, Jianing Liu, Yang Fan, Lizhi Xie, Jianwei Wang, published by Association of Radiology and Oncology
This work is licensed under the Creative Commons Attribution 4.0 License.

Previous articleVolume 59 (2025): Issue 4 (December 2025)Next article