Trastuzumab induced diastolic heart failure

Abstract

Background: Trastuzumab-induced cardiotoxicity has been well accepted. Cardiotoxicity especially with concomitant or sequential use of anthracycline has been clinically identified as decreased left ventricular ejection fraction with or without symptoms of heart failure. Acute diastolic heart failure has not been reported.

Case report: A 62-year-old female patient with HER2⁺ positive breast cancer presented to the emergency room with acute heart failure symptoms after trastuzumab use. Chest X-ray and CT demonstrated acute pulmonary edema. Echocardiography showed normal left ventricular ejection fraction, elevated left ventricular filling pressure, and moderate pulmonary hypertension, which are consistent with acute diastolic heart failure. The patient symptoms resolved quickly with diuretic therapy and Trastuzumab was discontinued. A follow-up echocardiography showed normal left and right ventricular function and a follow-up right heart catheterization demonstrated normal cardiac filling pressure and normal cardiac index.

Conclusions: Trastuzumab induced cardiac toxicity could occur in a spectrum-from transient diastolic heart failure to systolic heart failure. The monitoring of both diastolic and systolic function during the course of trastuzumab treatment with or without other chemotherapy agents should be considered.