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The clinical benefits of trastuzumab for treating women with human epidermal growth factor receptor 2 (HER2)-positive breast cancer are unquestioned. The use of this agent in combination with chemotherapy has dramatically improved outcomes for patients with early-stage breast cancer and has improved survival for patients with advanced disease. However, in the metastatic disease setting, the combination of trastuzumab plus an anthracycline has been associated with substantial risk for cardiotoxicity; thus, oncologists now usually avoid concurrent use of these agents. Despite these changes in trastuzumab use, certain patients still develop congestive heart failure, from which only some recover. The challenge is to identify those patients most…