Highlights
- •Previous prediction models include only baseline factors, which do not allow for real-time prediction of trastuzumab-induced cardiotoxicity.
- •Utilizing a single center retrospective observational cohort, we conducted model development and internal validation using a machine learning algorithm.
- •An integrated model, called the ABSDELL model based on 7 risk factors including age, BMI, SBP, DBP, E-wave, LVESD and LVEF, has been established to assist clinicians in adjusting monitoring strategies and detecting cardiotoxicity early based on up-to-date information gathered during follow-up.
Abstract
Introduction/Background
This study aims to establish an integrated model for predicting trastuzumab-associated
decline of Left ventricular ejection fraction (LVEF) during drug administration.
Methods
A retrospective study of 212 women who diagnosed with HER2-positive breast cancer
and treated with chemotherapy and trastuzumab was conducted. Medical records were
collected from 6 months before staring trastuzumab to 3 years afterwards. The least
absolute shrinkage and selection operator (LASSO) regression analysis was used to
select variables, time-dependent receiver operating characteristic (ROC) curve and
calibration plots were used to evaluate the model. The adjusted C-index and Brier
scores were calculated using a bootstrap internal validation procedure.
Results
The median age of participants is 53.2 years old. The median length of follow-up was
336 days. There were 72 patients (33.96%) whose LVEF declined ≥ 10% (10 absolute percent
points). Seven factors, namely age, body mass index (BMI), systolic blood pressure
(SBP), diastolic blood pressure (DBP), mitral peak E-wave velocity (E-wave), left
ventricular end-systolic diameter (LVESD) and LVEF, were selected. The name of the
ABSDELL model was formed by the initials of each predictor. The area under the curve
(AUC) of the model was 0.802 in 1 year and 0.881 in 3 years. Calibration plots indicate
the predicted and actual probabilities were highly consistent. In the internal validation,
1-year and 3-year adjusted C-index was 0.801 and 0.881, and adjusted Brier score was
0.118 and 0.091, separately.
Conclusion
The ABSDELL model can effectively predicts the probability of LVEF decline in breast
cancer patients treated with trastuzumab.
Keywords
Abbreviations:
A-wave (mitral peak A-wave velocity), BMI (body mass index), CKMB (creatine kinase isoenzyme-MB), DBP (diastolic blood pressure), eGFR (estimated glomerular filtration rate), Em (mitral annulus e' velocity), E-wave (mitral peak E-wave velocity), GLS (global longitudinal strain), HER2 (the human epidermal growth factor receptor 2), HF (heart failure), HGB (hemoglobin), HDL-C (high-density lipoprotein cholesterol), Hs-TnT (high-sensitive troponin T), LAA (left atrial area), LAD (left atrial diameter), LAP (left atrial pressure), LAVI (left atrial volume index), LDL-C (low-density lipoprotein cholesterol), LVEDD (left ventricular end-diastolic diameter), LVEF (left ventricular ejection fraction), LVESD (left ventricular end-systolic diameter), NT-proBNP (N-terminal pro-brain natriuretic peptide), RAA (right atrial area), SBP (systolic blood pressure), Scr (serum creatinine), Sm (mitral annulus s’ velocity), sST2 (soluble ST2), TCHO (total cholesterol), TG (triglyceride), TRV (tricuspid valve regurgitation velocity)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 22, 2022
Accepted:
October 16,
2022
Received in revised form:
October 11,
2022
Received:
April 29,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
