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Assessment of left ventricular function by CMR versus MUGA scans in breast cancer patients receiving trastuzumab: a prospective observational study
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 als...
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| Published in: | The International Journal of Cardiovascular Imaging 2019-11, Vol.35 (11), p.2085-2093 |
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| container_title | The International Journal of Cardiovascular Imaging |
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| creator | Dhir, Vinita Yan, Andrew T. Nisenbaum, Rosane Sloninko, Joanna Connelly, Kim A. Barfett, Joseph Haq, Rashida Kirpalani, Anish Chan, Kelvin K. W. Petrella, Teresa M. Brezden-Masley, Christine |
| description | 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 |
| doi_str_mv | 10.1007/s10554-019-01648-z |
| format | article |
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W. ; Petrella, Teresa M. ; Brezden-Masley, Christine</creator><creatorcontrib>Dhir, Vinita ; Yan, Andrew T. ; Nisenbaum, Rosane ; Sloninko, Joanna ; Connelly, Kim A. ; Barfett, Joseph ; Haq, Rashida ; Kirpalani, Anish ; Chan, Kelvin K. W. ; Petrella, Teresa M. ; Brezden-Masley, Christine</creatorcontrib><description>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.</description><identifier>ISSN: 1569-5794</identifier><identifier>EISSN: 1573-0743</identifier><identifier>EISSN: 1875-8312</identifier><identifier>DOI: 10.1007/s10554-019-01648-z</identifier><identifier>PMID: 31197526</identifier><language>eng</language><publisher>Dordrecht: Springer Netherlands</publisher><subject>Adult ; Antineoplastic Agents, Immunological - adverse effects ; Biomarkers ; Biomarkers - blood ; Brain ; Brain natriuretic peptide ; Breast cancer ; Breast Neoplasms - drug therapy ; Calcium-binding protein ; Cardiac Imaging ; Cardiac-Gated Imaging Techniques ; Cardiology ; Cardiotoxicity ; Correlation analysis ; Correlation coefficient ; Correlation coefficients ; ErbB-2 protein ; Female ; Health risk assessment ; Heart ; Humans ; Imaging ; Immunotherapy ; Magnetic resonance ; Magnetic Resonance Imaging ; Medicine ; Medicine & Public Health ; Middle Aged ; Monitoring ; Monoclonal antibodies ; Natriuretic Peptide, Brain - blood ; Observational studies ; Original Paper ; Peptide Fragments - blood ; Predictive Value of Tests ; Prospective Studies ; Radiation ; Radiation effects ; Radiology ; Radiopharmaceuticals - administration & dosage ; Reproducibility of Results ; Risk Factors ; Sodium Pertechnetate Tc 99m - administration & dosage ; Stroke Volume - drug effects ; Targeted cancer therapy ; Time Factors ; Tomography, Emission-Computed ; Trastuzumab ; Trastuzumab - adverse effects ; Treatment Outcome ; Troponin ; Troponin I - blood ; Ventricle ; Ventricular Dysfunction, Left - chemically induced ; Ventricular Dysfunction, Left - diagnostic imaging ; Ventricular Dysfunction, Left - physiopathology ; Ventricular Function, Left - drug effects</subject><ispartof>The International Journal of Cardiovascular Imaging, 2019-11, Vol.35 (11), p.2085-2093</ispartof><rights>Springer Nature B.V. 2019</rights><rights>The International Journal of Cardiovascular Imaging is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-cf86c0f45d6bbeac0a6a09faff2b37909368b51da84e3292f16a98bd80b193903</citedby><cites>FETCH-LOGICAL-c375t-cf86c0f45d6bbeac0a6a09faff2b37909368b51da84e3292f16a98bd80b193903</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31197526$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Dhir, Vinita</creatorcontrib><creatorcontrib>Yan, Andrew T.</creatorcontrib><creatorcontrib>Nisenbaum, Rosane</creatorcontrib><creatorcontrib>Sloninko, Joanna</creatorcontrib><creatorcontrib>Connelly, Kim A.</creatorcontrib><creatorcontrib>Barfett, Joseph</creatorcontrib><creatorcontrib>Haq, Rashida</creatorcontrib><creatorcontrib>Kirpalani, Anish</creatorcontrib><creatorcontrib>Chan, Kelvin K. W.</creatorcontrib><creatorcontrib>Petrella, Teresa M.</creatorcontrib><creatorcontrib>Brezden-Masley, Christine</creatorcontrib><title>Assessment of left ventricular function by CMR versus MUGA scans in breast cancer patients receiving trastuzumab: a prospective observational study</title><title>The International Journal of Cardiovascular Imaging</title><addtitle>Int J Cardiovasc Imaging</addtitle><addtitle>Int J Cardiovasc Imaging</addtitle><description>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.</description><subject>Adult</subject><subject>Antineoplastic Agents, Immunological - adverse effects</subject><subject>Biomarkers</subject><subject>Biomarkers - blood</subject><subject>Brain</subject><subject>Brain natriuretic peptide</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - drug therapy</subject><subject>Calcium-binding protein</subject><subject>Cardiac Imaging</subject><subject>Cardiac-Gated Imaging Techniques</subject><subject>Cardiology</subject><subject>Cardiotoxicity</subject><subject>Correlation analysis</subject><subject>Correlation coefficient</subject><subject>Correlation coefficients</subject><subject>ErbB-2 protein</subject><subject>Female</subject><subject>Health risk assessment</subject><subject>Heart</subject><subject>Humans</subject><subject>Imaging</subject><subject>Immunotherapy</subject><subject>Magnetic resonance</subject><subject>Magnetic Resonance Imaging</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Monitoring</subject><subject>Monoclonal antibodies</subject><subject>Natriuretic Peptide, Brain - blood</subject><subject>Observational studies</subject><subject>Original Paper</subject><subject>Peptide Fragments - blood</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Radiation</subject><subject>Radiation effects</subject><subject>Radiology</subject><subject>Radiopharmaceuticals - administration & dosage</subject><subject>Reproducibility of Results</subject><subject>Risk Factors</subject><subject>Sodium Pertechnetate Tc 99m - administration & dosage</subject><subject>Stroke Volume - drug effects</subject><subject>Targeted cancer therapy</subject><subject>Time Factors</subject><subject>Tomography, Emission-Computed</subject><subject>Trastuzumab</subject><subject>Trastuzumab - adverse effects</subject><subject>Treatment Outcome</subject><subject>Troponin</subject><subject>Troponin I - blood</subject><subject>Ventricle</subject><subject>Ventricular Dysfunction, Left - chemically induced</subject><subject>Ventricular Dysfunction, Left - diagnostic imaging</subject><subject>Ventricular Dysfunction, Left - physiopathology</subject><subject>Ventricular Function, Left - drug effects</subject><issn>1569-5794</issn><issn>1573-0743</issn><issn>1875-8312</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp9UU1rGzEQFSWlSdP-gR6CIOdtR9J-KTdj0rSQUCjNWUjaUdhg7zqaXYP9N_qHM67T9NbDoBnemzcPPSE-KfisAJovpKCqygKU5arLtti_EWeqakwBTWlODn1ti6qx5al4T_QIABq0eSdOjVK2qXR9Jn4viJBojcMkxyRXmCa55SH3cV75LNM8xKkfBxl2cnn3k7FMM8m7-5uFpOgHkj1jGT1NkseIWW781LMCyYwR-20_PMgpMz7v57UPV9LLTR5pg6y7RTkGwrz1hxt-JZnV7T6It8mvCD--vOfi_uv1r-W34vbHzffl4raIpqmmIqa2jpDKqqtDQB_B1x5s8inpYBoL1tRtqFTn2xKNtjqp2ts2dC0EZY0Fcy4uj7rs52lGmtzjOGe2QU5rY8tSgVLM0kdWZNeUMblN7tc-75wCd8jBHXNwnIP7k4Pb89LFi_Qc1ti9rvz9eCaYI4EYGh4w_7v9H9lneAWXVg</recordid><startdate>20191101</startdate><enddate>20191101</enddate><creator>Dhir, Vinita</creator><creator>Yan, Andrew T.</creator><creator>Nisenbaum, Rosane</creator><creator>Sloninko, Joanna</creator><creator>Connelly, Kim A.</creator><creator>Barfett, Joseph</creator><creator>Haq, Rashida</creator><creator>Kirpalani, Anish</creator><creator>Chan, Kelvin K. W.</creator><creator>Petrella, Teresa M.</creator><creator>Brezden-Masley, Christine</creator><general>Springer Netherlands</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope></search><sort><creationdate>20191101</creationdate><title>Assessment of left ventricular function by CMR versus MUGA scans in breast cancer patients receiving trastuzumab: a prospective observational study</title><author>Dhir, Vinita ; Yan, Andrew T. ; Nisenbaum, Rosane ; Sloninko, Joanna ; Connelly, Kim A. ; Barfett, Joseph ; Haq, Rashida ; Kirpalani, Anish ; Chan, Kelvin K. W. ; Petrella, Teresa M. ; Brezden-Masley, Christine</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-cf86c0f45d6bbeac0a6a09faff2b37909368b51da84e3292f16a98bd80b193903</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Antineoplastic Agents, Immunological - adverse effects</topic><topic>Biomarkers</topic><topic>Biomarkers - blood</topic><topic>Brain</topic><topic>Brain natriuretic peptide</topic><topic>Breast cancer</topic><topic>Breast Neoplasms - drug therapy</topic><topic>Calcium-binding protein</topic><topic>Cardiac Imaging</topic><topic>Cardiac-Gated Imaging Techniques</topic><topic>Cardiology</topic><topic>Cardiotoxicity</topic><topic>Correlation analysis</topic><topic>Correlation coefficient</topic><topic>Correlation coefficients</topic><topic>ErbB-2 protein</topic><topic>Female</topic><topic>Health risk assessment</topic><topic>Heart</topic><topic>Humans</topic><topic>Imaging</topic><topic>Immunotherapy</topic><topic>Magnetic resonance</topic><topic>Magnetic Resonance Imaging</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Monitoring</topic><topic>Monoclonal antibodies</topic><topic>Natriuretic Peptide, Brain - blood</topic><topic>Observational studies</topic><topic>Original Paper</topic><topic>Peptide Fragments - blood</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Radiation</topic><topic>Radiation effects</topic><topic>Radiology</topic><topic>Radiopharmaceuticals - administration & dosage</topic><topic>Reproducibility of Results</topic><topic>Risk Factors</topic><topic>Sodium Pertechnetate Tc 99m - administration & dosage</topic><topic>Stroke Volume - drug effects</topic><topic>Targeted cancer therapy</topic><topic>Time Factors</topic><topic>Tomography, Emission-Computed</topic><topic>Trastuzumab</topic><topic>Trastuzumab - adverse effects</topic><topic>Treatment Outcome</topic><topic>Troponin</topic><topic>Troponin I - blood</topic><topic>Ventricle</topic><topic>Ventricular Dysfunction, Left - chemically induced</topic><topic>Ventricular Dysfunction, Left - diagnostic imaging</topic><topic>Ventricular Dysfunction, Left - physiopathology</topic><topic>Ventricular Function, Left - drug effects</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Dhir, Vinita</creatorcontrib><creatorcontrib>Yan, Andrew T.</creatorcontrib><creatorcontrib>Nisenbaum, Rosane</creatorcontrib><creatorcontrib>Sloninko, Joanna</creatorcontrib><creatorcontrib>Connelly, Kim A.</creatorcontrib><creatorcontrib>Barfett, Joseph</creatorcontrib><creatorcontrib>Haq, Rashida</creatorcontrib><creatorcontrib>Kirpalani, Anish</creatorcontrib><creatorcontrib>Chan, Kelvin K. W.</creatorcontrib><creatorcontrib>Petrella, Teresa M.</creatorcontrib><creatorcontrib>Brezden-Masley, Christine</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>Biochemistry Abstracts 1</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><jtitle>The International Journal of Cardiovascular Imaging</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Dhir, Vinita</au><au>Yan, Andrew T.</au><au>Nisenbaum, Rosane</au><au>Sloninko, Joanna</au><au>Connelly, Kim A.</au><au>Barfett, Joseph</au><au>Haq, Rashida</au><au>Kirpalani, Anish</au><au>Chan, Kelvin K. W.</au><au>Petrella, Teresa M.</au><au>Brezden-Masley, Christine</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Assessment of left ventricular function by CMR versus MUGA scans in breast cancer patients receiving trastuzumab: a prospective observational study</atitle><jtitle>The International Journal of Cardiovascular Imaging</jtitle><stitle>Int J Cardiovasc Imaging</stitle><addtitle>Int J Cardiovasc Imaging</addtitle><date>2019-11-01</date><risdate>2019</risdate><volume>35</volume><issue>11</issue><spage>2085</spage><epage>2093</epage><pages>2085-2093</pages><issn>1569-5794</issn><eissn>1573-0743</eissn><eissn>1875-8312</eissn><abstract>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.</abstract><cop>Dordrecht</cop><pub>Springer Netherlands</pub><pmid>31197526</pmid><doi>10.1007/s10554-019-01648-z</doi><tpages>9</tpages></addata></record> |
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| subjects | Adult Antineoplastic Agents, Immunological - adverse effects Biomarkers Biomarkers - blood Brain Brain natriuretic peptide Breast cancer Breast Neoplasms - drug therapy Calcium-binding protein Cardiac Imaging Cardiac-Gated Imaging Techniques Cardiology Cardiotoxicity Correlation analysis Correlation coefficient Correlation coefficients ErbB-2 protein Female Health risk assessment Heart Humans Imaging Immunotherapy Magnetic resonance Magnetic Resonance Imaging Medicine Medicine & Public Health Middle Aged Monitoring Monoclonal antibodies Natriuretic Peptide, Brain - blood Observational studies Original Paper Peptide Fragments - blood Predictive Value of Tests Prospective Studies Radiation Radiation effects Radiology Radiopharmaceuticals - administration & dosage Reproducibility of Results Risk Factors Sodium Pertechnetate Tc 99m - administration & dosage Stroke Volume - drug effects Targeted cancer therapy Time Factors Tomography, Emission-Computed Trastuzumab Trastuzumab - adverse effects Treatment Outcome Troponin Troponin I - blood Ventricle Ventricular Dysfunction, Left - chemically induced Ventricular Dysfunction, Left - diagnostic imaging Ventricular Dysfunction, Left - physiopathology Ventricular Function, Left - drug effects |
| title | Assessment of left ventricular function by CMR versus MUGA scans in breast cancer patients receiving trastuzumab: a prospective observational study |
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