Cardiac Magnetic Resonance Imaging Findings in Human Epidermal Growth Factor Receptor 2-Targeted Therapy-Related Cardiotoxicity

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A 41-year-old female with human epidermal growth factor receptor 2 (HER2) (+) metastatic breast cancer was admitted due to exertional dyspnea and othopnea.She had received 3 cycles of the combination of paclitaxel, trastuzumab, and pertuzumab, and her past medical history was unremarkable.Physical examination revealed bilateral crackles at the lower lung zones and S3 sound with pansystolic 3/6 murmur at apex.Electrocardiogram was consistent with sinus tachycardia (110 bpm) and loss of R wave progression.Her blood tests were all normal, except for the increased levels of BNP (216 pg/mL).Echocardiographic evaluation yielded a reduced left ventricular ejection fraction (LVEF = 20%) and severe mitral and tricuspid regurgitation.Coronary angiography was performed after decongestive treatment.Coronary arteries were normal, and cardiac magnetic resonance imaging (MRI) showed myocardial edema and pericardial effusion.Extracellular volume (ECV) was also increased (Figure 1).Septal epicardial late gadolinium