{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T17:22:33Z","timestamp":1781112153000,"version":"3.54.1"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"15","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,8,7]]},"abstract":"\n Background<\/jats:title>\n \n Trastuzumab is life\u2010extending therapy for breast cancer patients overexpressing the human epidermal growth factor receptor 2 (\n HER<\/jats:styled-content>\n 2+), but has known cardiotoxic risk. We sought to determine if trastuzumab can be administered to patients with reduced baseline cardiac function at no higher cardiotoxicity risk than in those with normal cardiac function at baseline.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n We performed a retrospective study of women treated with trastuzumab for human epidermal growth factor receptor 2 breast cancer at Mayo Clinic Rochester between January 1, 2000 and August 31, 2015 with pre\u2010 and on\u2010therapy echocardiograms available for review. A left ventricular ejection fraction (LVEF) <53% was considered abnormal, and a \u226510% decline in\n LVEF<\/jats:styled-content>\n as evidence of cardiotoxicity based on the criteria of the American Society of Echocardiography. A total of 428 women were identified; 408 had a normal cardiac function (\n LVEF<\/jats:styled-content>\n 63.4\u00b15%) and 20 had an impaired cardiac function (\n LVEF<\/jats:styled-content>\n 45.4\u00b17%) before trastuzumab. Seven women (35%) with reduced\n LVEF<\/jats:styled-content>\n at baseline had a \u226510% reduction in\n LVEF<\/jats:styled-content>\n , compared with 179 (43.9%) of those with normal\n LVEF<\/jats:styled-content>\n before trastuzumab initiation (\n P<\/jats:italic>\n =\n NS<\/jats:styled-content>\n ). Symptomatic heart failure developed more often in patients with reduced versus normal baseline\n LVEF<\/jats:styled-content>\n (25% versus 4.2%,\n P<\/jats:italic>\n <0.05). After adjusting for patient age and breast cancer disease stage, survival rates over 5\u00a0years from time of diagnosis were found to be lower for patients with reduced baseline\n LVEF<\/jats:styled-content>\n compared with patients with normal baseline\n LVEF<\/jats:styled-content>\n (\n P<\/jats:italic>\n <0.001); the adjusted proportion of patients surviving at 5\u00a0years for those with low\n LVEF<\/jats:styled-content>\n at baseline was 79% and for those with normal\n LVEF<\/jats:styled-content>\n was 93%.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Women undergoing trastuzumab therapy for breast cancer with impaired baseline cardiac function experience no higher risk of\n LVEF<\/jats:styled-content>\n decline, but more frequently develop symptomatic heart failure. While trastuzumab could be considered, these patients should be co\u2010managed by a cardiologist.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.118.008637","type":"journal-article","created":{"date-parts":[[2018,9,16]],"date-time":"2018-09-16T06:43:15Z","timestamp":1537080195000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":43,"title":["Trastuzumab in Female Breast Cancer Patients With Reduced Left Ventricular Ejection Fraction"],"prefix":"10.1161","volume":"7","author":[{"given":"Somaira","family":"Nowsheen","sequence":"first","affiliation":[{"name":"Mayo Clinic School of Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled","family":"Aziz","sequence":"additional","affiliation":[{"name":"Mayo Clinic School of Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae Yoon","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amir","family":"Lerman","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hector R.","family":"Villarraga","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn Jean","family":"Ruddy","sequence":"additional","affiliation":[{"name":"Division of Medical Oncology Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joerg","family":"Herrmann","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic Rochester MN"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/35052073"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrc1360"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1126\/science.3798106"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa052306"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1999.17.9.2639"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrc2106"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cardfail.2008.02.002"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2009.27.3615"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2012-303151"},{"key":"e_1_3_1_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0025-6196(11)60840-9"},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2002.20.5.1215"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(11)70033-X"},{"key":"e_1_3_1_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)60028-2"},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa052306"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa052122"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2015.65"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.05.827"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.10854"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.tcm.2014.07.003"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mayocp.2014.05.013"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2010.121"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200103153441101"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeu192"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.1111\/echo.12331"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2014.55.5730"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1413513"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.40.0010"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.113.000472"},{"key":"e_1_3_1_30_2","first-page":"1717","article-title":"Factors predicting trastuzumab\u2010related cardiotoxicity in a real\u2010world population of women with her2+ breast cancer","volume":"33","author":"Naumann D","year":"2013","unstructured":"Naumann D, Rusius V, Margiotta C, Nevill A, Carmichael A, Rea D, Sintler M. Factors predicting trastuzumab\u2010related cardiotoxicity in a real\u2010world population of women with her2+ breast cancer. Anticancer Res. 2013;33:1717\u20131720.","journal-title":"Anticancer Res"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2015.3709"},{"key":"e_1_3_1_32_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2015.61.8413"},{"key":"e_1_3_1_33_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)32616-2"},{"key":"e_1_3_1_34_2","doi-asserted-by":"crossref","unstructured":"Slamon DJ EW Robert NJ Giermek J Martin M Jasiowka M Mackey JR Chan A Liu M\u2010C Pinter T Valero V Falkson C Fornander T Shiftan TA Bensfia S Hitier S Xu N B\u00e9e\u2010Munteanu V Drevot P Press MF Crown J; On Behalf of the BCIRG\u2010006 Investigators. UCLA Los Angeles CA; GBG Munchen Germany; USO The Woodlands TX; Maria Sklodowska\u2010Curie Centre Warsaw Poland; GEICAM Madrid Spain; Maria Sklodowska\u2010Curie Memorial Cancer Institute Krakow Poland; Cross Cancer Institute Edmonton Canada; Breast Cancer Research Centre \u2010 WA & Curtin University Perth Australia; Sun Yat\u2010Sen Cancer Center Taipei Taiwan; Petz Aladar Megyei Oktato Korhaz Onkoradiologica Gyor Hungary; The University of Texas MD Anderson Cancer Centre Houston TX; University of Alabama Birmingham AL; Karolinska University Hospital Stockholm Sweden; Sharp Memorial Hospital San Diego CA; Sanofi Cambridge; Sanofi Chilly\u2010Mazarin France; Genentech South San Francisco CA; TRIO Paris France; USC\/Norris Comprehensive Cancer Center Los Angeles CA; ICORG Dublin Ireland . Ten year follow\u2010up of BCIRG\u2010006 comparing doxorubicin plus cyclophosphamide followed by docetaxel (AC\u2192T) with doxorubicin plus cyclophosphamide followed by docetaxel and trastuzumab (AC\u2192TH) with docetaxel carboplatin and trastuzumab (TCH) in HER2+ early breast cancer. San Antonio Breast Cancer Symposium. Abstract S5\u201004. 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