Assessment of left ventricular function by CMR versus MUGA scans in breast cancer patients receiving trastuzumab: a prospective observational study

  • Vinita Dhir
  • Andrew T. Yan
  • Rosane Nisenbaum
  • Joanna Sloninko
  • Kim A. Connelly
  • Joseph Barfett
  • Rashida Haq
  • Anish Kirpalani
  • Kelvin K. W. Chan
  • Teresa M. Petrella
  • Christine Brezden-MasleyEmail author
Original Paper


Little is known about the comparison of multiple-gated acquisition (MUGA) scanning with cardiovascular magnetic resonance (CMR) for serial monitoring of HER2+ breast cancer patients receiving trastuzumab. The association of cardiac biomarkers with CMR left ventricular (LV) function and volume is also not well studied. Our objectives were to compare CMR and MUGA for left ventricular ejection fraction (LVEF) assessment, and to examine the association between changes in brain natriuretic peptide (NT-BNP) and troponin-I and changes in CMR LV function and volume. This prospective longitudinal two-centre cohort study recruited HER2+ breast cancer patients between January 2010 and December 2013. MUGA, CMR, NT-BNP and troponin-I were performed at baseline, 6, 12, and 18 months after trastuzumab initiation. In total, 41 patients (age 51.7 ± 10.8 years) were enrolled. LVEF comparison between MUGA and CMR demonstrated weak agreement (Lin’s correlation coefficient r = 0.46, baseline; r = 0.29, 6 months; r = 0.42, 12 months; r = 0.39, 18 months; all p < 0.05). Bland–Altman plots demonstrated wide LVEF agreement limits (pooled agreement limits 3.0 ± 6.2). Both modalities demonstrated significant LVEF decline at 6 and 12 months from baseline, concomitant with increased LV volumes on CMR. Changes in NT-BNP correlated with changes in LV diastolic volume at 12 and 18 months (p < 0.05), and LV systolic volume at 18 months (p < 0.05). Changes in troponin-I did not correlate with changes in LV function or volume at any timepoint. In conclusion, CMR and MUGA LVEF are not interchangeable, warranting selection and utility of one modality for serial monitoring. CMR is useful due to less radiation exposure and accuracy of LV volume measurements. Changes in NT-BNP correlated with changes in LV volumes.


Breast cancer Trastuzumab Cardiotoxicity Cardiovascular magnetic resonance MUGA LVEF 



We would like to thank all the study participants who contributed their time to this research study. We also acknowledge the study coordinators for their efforts in data collection. This work was supported by a Canadian Institute of Health Research Industry partnered grant with Hoffman-La Roche Canada Inc.


This work was supported by a Canadian Institute of Health Research Industry partnered grant with Hoffman-La Roche Canada Inc.

Compliance with ethical standards

Conflict of Interest

C. Brezden-Masley has received research grant support and/or honoraria for educational activities and/or served as consultant to Roche.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committees (St. Michael’s Hospital and Sunnybrook Odette Cancer Centre) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  • Vinita Dhir
    • 1
  • Andrew T. Yan
    • 2
    • 3
    • 4
  • Rosane Nisenbaum
    • 5
  • Joanna Sloninko
    • 6
  • Kim A. Connelly
    • 2
    • 3
    • 4
  • Joseph Barfett
    • 6
  • Rashida Haq
    • 1
    • 3
  • Anish Kirpalani
    • 3
    • 4
    • 6
  • Kelvin K. W. Chan
    • 3
    • 7
    • 8
  • Teresa M. Petrella
    • 3
    • 7
  • Christine Brezden-Masley
    • 1
    • 3
    • 4
    Email author
  1. 1.Division of Hematology/OncologySt. Michael’s HospitalTorontoCanada
  2. 2.Terrence Donnelly Heart CentreSt. Michael’s HospitalTorontoCanada
  3. 3.University of TorontoTorontoCanada
  4. 4.Keenan Research Centre of the Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoCanada
  5. 5.Centre for Urban Health Solutions of the Li Ka Shing Knowledge InstituteSt. Michael’s HospitalTorontoCanada
  6. 6.Department of Medical ImagingSt. Michael’s HospitalTorontoCanada
  7. 7.Sunnybrook Odette Cancer CentreTorontoCanada
  8. 8.The Canadian Centre for Applied Research in Cancer ControlTorontoCanada

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