Cardiac monitoring should be prioritized among patients undergoing treatment with certain therapies for breast cancer who are at high risk for heart failure, according to a study published in JACC: Cardiovascular Imaging.1

Cardiac toxicity is a well-known adverse event associated with certain anticancer therapies and leads to poor outcomes and high mortality risk among breast cancer survivors. There is a paucity of data regarding the cardiotoxicity and the monitoring adherence habits of patients undergoing treatment with trastuzumab or anthracyclines, which are commonly used therapies among patients with HER2-positive breast cancer.

For this study, researchers evaluated the outcomes of 16,456 patients with breast cancer who received chemotherapy within 6 months of breast cancer diagnosis. Cardiac toxicity was defined as an incident case of heart failure post-breast cancer diagnosis. The median age of study participants was 56 years, and 4325 patients received trastuzumab.

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Overall, 4.2% of patients developed heart failure. Of patients treated with trastuzumab, 8.3% developed heart failure compared with 2.7% of patients who received other chemotherapies (P < .001). The rate of heart failure was 4.6% and 4.0% among patients who received anthracycline versus non-anthracycline therapies, respectively (P = .048), and hypertension and valve disease were also associated with an increased risk of cardiotoxicity.

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Further analysis revealed that only 46.2% of trastuzumab-receiving patients underwent guideline-adhering cardiac monitoring; according to recommendations from the National Comprehensive Cancer Network, patients should be monitored at baseline 4 months before the first trastuzumab dose and every 4 months while receiving the medication.

Advanced age was also associated with increased risk of heart failure. Previous studies emphasized cardiovascular risk among older women, but as younger women receive more aggressive treatment and likely survive longer, it is important to have a better understanding of toxicity and monitoring for this patient population.

The authors concluded that “the number of cancer survivors is expected to increase over time, and we will continue to see patients develop treatment-related cardiotoxicity. Thus, more research, evidence-based guidelines, and tools for prediction of cancer treatment-related cardiotoxicity are needed.”


  1. Henry ML, Niu J, Zhang N, Giordano SH, Chavez-MacGregor M. Cardiotoxicity and cardiac monitoring among chemotherapy-treated breast cancer patients. JACC Cardiovasc Imaging. 2018;11(8):1084-1093.