Evaluation of Myocardial Changes During BReast Adenocarcinoma Therapy to Detect Cardiotoxicity Earlier With MRI - The EMBRACE MRI Study
Breast cancer is the most common cancer amongst Canadian women. 15-20% of early breast
cancers have high levels of a protein called HER2 which is associated with worse survival.
Treatment of these patients with anthracyclines followed by trastuzumab (which targets HER2)
improves survival. Unfortunately, these medications together can cause heart muscle injury
resulting in heart dysfunction or failure in about 14% and 3.6% of the patients,
respectively. Once heart failure (HF) occurs, about 60% of patients will not live past 2
years. Studies have suggested that patients with heart injury caused by anthracyclines may
be more likely to develop HF with addition of trastuzumab. Therefore tests to find early
heart injury after anthracyclines may allow doctors to start heart protective medications
with the hope of preventing HF. Also, animal and small patient studies have shown that an
increase in the water levels of the heart muscle (edema) may be an early sign of heart
injury from anthracyclines. Cardiac MRI is a unique technique that has been shown to detect
edema in various heart diseases.
The investigators will test the theory that, in women receiving treatment for breast cancer,
heart edema detected by MRI at the end of anthracyclines will identify patients who will
later develop heart dysfunction. MRI studies with novel techniques will be done pre-therapy,
after anthracyclines, during herceptin, and at end of all therapy. The investigators will
compare patients with and without heart dysfunction to test if patients with heart
dysfunction are more likely to have edema after anthracyclines. Ultimately the investigators
hope to use cardiac MRI to identify high risk patients and study various heart protective
medications to prevent HF. This will improve the personal health of cancer patients by
allowing them to live free of heart disease after their cancer therapy. Ultimately at a
population level this will allow doctors to provide care that can be uniquely designed for
each patient based on their individual risk.
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