Objectives Long-term follow-up of patients treated with trastuzumab largely focuses on those with reduced left ventricular ejection fraction (LVEF) on treatment completion. This study sought to evaluate the prevalence of cardiovascular risk factors, overt cardiovascular disease and cardiac imaging abnormalities using cardiac magnetic resonance (CMR), in participants with normal LVEF on completion of trastuzumab±anthracycline therapy at least 5 years previously. Methods Participants with human epidermal growth factor receptor 2-positive breast cancer treated with trastuzumab±anthracycline ≥5 years previously were identified from a clinical database. All participants had normal LVEF prior to, and on completion of, treatment. Participants underwent clinical cardiovascular evaluation, ECG, cardiac biomarker evaluation and CMR. Left ventricular systolic dysfunction (LVSD) was defined as LVEF <50%. Results Forty participants were recruited between 15 March 2021 and 19 July 2022. Median time since completion of trastuzumab was 7.8 years (range 5.9–10.8 years) and 90% received prior anthracycline. 25% of participants had LVSD; median LVEF was 55.2% (Q1–Q3, 51.3–61.2). 30% of participants had N-terminal pro-B-type natriuretic peptide >125 pg/mL and 8% had high-sensitivity cardiac troponin T >14 ng/L. 33% of participants had a new finding of hypertension. 58% had total cholesterol >5.0 mmol/L, 43% had triglycerides >1.7 mmol/L and 5% had a new diagnosis of diabetes. Conclusions The presence of asymptomatic LVSD, abnormal cardiac biomarkers and cardiac risk factors in participants treated with trastuzumab and anthracycline at least 5 years previously is common, even in those with normal LVEF on completion of treatment. Our findings reinforce the relevance of comprehensive evaluation of cardiovascular risk factors following completion of cancer therapy, in addition to LVEF assessment. All data relevant to the study are included in the article or uploaded as supplemental information. Data access requests should be initially submitted by email to the Chief Investigator.

中文翻译：

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曲妥珠单抗和蒽环类药物对乳腺癌长期幸存者的心血管后遗症

目的 对接受曲妥珠单抗治疗的患者进行长期随访主要关注治疗完成后左心室射血分数 (LVEF) 降低的患者。本研究旨在利用心脏磁共振 (CMR) 评估至少 5 年前完成曲妥珠单抗±蒽环类药物治疗后 LVEF 正常的受试者中心血管危险因素、明显的心血管疾病和心脏影像异常的患病率。方法 从临床数据库中筛选出 5 年前接受曲妥珠单抗±蒽环类药物治疗的人类表皮生长因子受体 2 阳性乳腺癌参与者。所有参与者在治疗前和治疗完成后的 LVEF 均正常。参与者接受了临床心血管评估、心电图、心脏生物标志物评估和 CMR。左心室收缩功能障碍（LVSD）定义为 LVEF <50%。结果 2021 年 3 月 15 日至 2022 年 7 月 19 日期间招募了 40 名参与者。完成曲妥珠单抗治疗后的中位时间为 7.8 年（范围 5.9-10.8 年），90% 的人之前接受过蒽环类药物治疗。 25% 的参与者患有 LVSD；中位 LVEF 为 55.2%（Q1-Q3，51.3-61.2）。 30% 的参与者 N 端 B 型利钠肽原 >125 pg/mL，8% 的高敏心肌肌钙蛋白 T >14 ng/L。 33% 的参与者新发现了高血压。 58% 的人总胆固醇>5.0 mmol/L，43% 的人甘油三酯>1.7 mmol/L，5% 的人新诊断出糖尿病。结论 在至少 5 年前接受曲妥珠单抗和蒽环类药物治疗的参与者中，存在无症状 LVSD、异常心脏生物标志物和心脏危险因素的情况很常见，即使是在治疗完成后 LVEF 正常的参与者中也是如此。我们的研究结果强化了除了 LVEF 评估之外，癌症治疗完成后对心血管危险因素进行综合评估的相关性。与研究相关的所有数据都包含在文章中或作为补充信息上传。数据访问请求应首先通过电子邮件提交给首席研究员。