BACKGROUND: Trastuzumab, a HER2 monoclonal antibody, has transformed the 
prognosis of patients with the aggressive HER2-positive breast cancer type. 
Trastuzumab augments the cardiotoxic effects of anthracyclines, but its effect 
is thought to be at least partially reversible. The objective of this study was 
to examine the time trends of left ventricular (LV) size and function in a 
cohort of women treated with anthracyclines and trastuzumab.
METHODS: Twenty-nine patients >18 years of age with first-time breast cancer 
treated with anthracyclines and trastuzumab were monitored using 
echocardiography before, at the completion of, and at a median follow-up of 24.7 
months (interquartile range, 15.9-34 months) after the end of their cancer 
treatment. LV volume, LV ejection fraction, and global peak systolic 
longitudinal strain and strain rate were measured in the apical four- and 
two-chamber views. Left ventricular ejection fraction was measured using a 
modified Simpson's biplane method.
RESULTS: LV end-diastolic and end-systolic volumes increased at the end of 
treatment compared with baseline and did not recover during follow-up. Left 
ventricular ejection fraction, strain, and strain rate decreased at the end of 
treatment compared with baseline (from 64 ± 6% to 59 ± 8%, from -20.0 ± 2.5% to 
-17.6 ± 2.6%, and from -1.26 ± 0.23 to -1.13 ± 0.16 sec(-1), respectively; 
P < .05 for all parameters) and remained decreased at follow-up.
CONCLUSIONS: LV dilation and subclinical impairment in cardiac function persists 
>2 years after the end of anthracycline and trastuzumab treatment, without 
significant recovery after trastuzumab cessation, suggestive of long-term 
underlying cardiac damage and remodeling.