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Qiu Y, Jiang P, Huang Y. Anthracycline-induced cardiotoxicity: mechanisms, monitoring, and prevention. Front Cardiovasc Med 2023; 10:1242596. [PMID: 38173817 PMCID: PMC10762801 DOI: 10.3389/fcvm.2023.1242596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Anthracyclines are the most fundamental and important treatment of several cancers especially for lymphoma and breast cancer. However, their use is limited by a dose-dependent cardiotoxicity which may emerge early at the initiation of anthracycline administration or several years after termination of the therapy. A full comprehending of the mechanisms of anthracycline-induced cardiotoxicity, which has not been achieved and is currently under the efforts, is critical to the advance of developing effective methods to protect against the cardiotoxicity, as well as to early detect and treat it. Therefore, we review the recent progress of the mechanism underlying anthracycline-induced cardiotoxicity, as well as approaches to monitor and prevent this issue.
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Affiliation(s)
- Yun Qiu
- Department of Cardiology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Piao Jiang
- Department of Oncology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
- The First Clinical Medical College, Nanchang University, Nanchang, China
| | - Yingmei Huang
- Department of Cardiology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
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2
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Mertens L, Singh G, Armenian S, Chen MH, Dorfman AL, Garg R, Husain N, Joshi V, Leger KJ, Lipshultz SE, Lopez-Mattei J, Narayan HK, Parthiban A, Pignatelli RH, Toro-Salazar O, Wasserman M, Wheatley J. Multimodality Imaging for Cardiac Surveillance of Cancer Treatment in Children: Recommendations From the American Society of Echocardiography. J Am Soc Echocardiogr 2023; 36:1227-1253. [PMID: 38043984 DOI: 10.1016/j.echo.2023.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Affiliation(s)
- Luc Mertens
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Gautam Singh
- Children's Hospital of Michigan, Detroit, Michigan; Central Michigan University School of Medicine, Saginaw, Michigan
| | - Saro Armenian
- City of Hope Comprehensive Cancer Center, Duarte, California
| | - Ming-Hui Chen
- Boston Children's Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Adam L Dorfman
- University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - Ruchira Garg
- Cedars-Sinai Heart Institute, Los Angeles, California
| | | | - Vijaya Joshi
- St. Jude Children's Research Hospital/University of Tennessee College of Medicine, Memphis, Tennessee
| | - Kasey J Leger
- University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Steven E Lipshultz
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Oishei Children's Hospital, Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | | | - Hari K Narayan
- University of California San Diego, Rady Children's Hospital San Diego, San Diego, California
| | - Anitha Parthiban
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | | | - Olga Toro-Salazar
- Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, Connecticut
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Zheng Y, Liu H, Zhao L, Guan S, Huo H, Li H, Guo J, Peng X, Hao Y, Jin S, Hou Y, Dai X, Liu T, Zhang X. Serial Cardiac MRI for Quantification of the Dynamics of Anthracycline-Induced Subclinical Myocardial Injury. J Magn Reson Imaging 2023; 58:1533-1541. [PMID: 36912379 DOI: 10.1002/jmri.28667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Anthracyclines are known to be associated with chemotherapy-induced cardiotoxicity. Limited data focus on dynamic myocardial injury during the course of chemotherapy in patients with breast cancer. PURPOSE To investigate the variation of tissue characterization and myocardial deformation derived by cardiac MRI during anthracycline chemotherapy. STUDY TYPE Prospective. POPULATION Fifty-eight female breast cancer patients (mean age: 52.82 ± 2.61 years) were enrolled. FIELD STRENGTH/SEQUENCE A 3.0-T, cardiac MRI including cine balanced steady-state free precession, a modified Looker-Locker inversion recovery (MOLLI), and a fast spin echo (FSE) T2-weighted sequences were performed. ASSESSMENT Cardiac MRI was performed baseline and after two, four, and six cycles of chemotherapy. Assessment of global longitudinal strain (GLS), global circumstance strain (GCS), global radial strain (GRS), and strain rate (GLS-s, GCS-s, GRS-s) and T1, T2 and T2* were accomplished by CVI42. The anthracycline dose and risk factors were also collected before each cardiac MRI. STATISTICAL TESTS Analysis of variance (ANOVA) for repeated measures was used to compare the changes in LVEF cardiac function, strain and T1/T2/T2* parameters over time. Pearson correlation analyses were performed to estimate the potential associations between differences in myocardial characteristics (∆) and the chemotherapy cycle. A P value <0.05 was considered statistically significant. RESULTS LVEF was not significantly different from pretreatment MRI regarding each cycle of chemotherapy (P = 0.54). Compared with baseline, patients had significantly lower GLS (-15.85% ± 0.83%, -14.50% ± 0.88%, -12.34% ± 1.01% vs. -18.82% ± 0.92%) and GLS-s (-0.71% ± 0.07%, -0.65% ± 0.05%, -0.64% ± 0.04% vs. -0.95 ± 0.06%) and increased T2 values (57.21 ± 4.27 msec, 58.60 ± 3.93 msec, 58.10 ± 3.17 msec vs. 43.88 ± 3.28 msec) at two, four and six cycles of chemotherapy treatment. ∆GLS and ∆GLS-s were significantly associated with the chemotherapy cycle (correlation coefficients for GLS = 0.75, GLS-s = 0.75). DATA CONCLUSION Cardiac MRI can precisely detect the dynamic changes of anthracycline-induced subclinical myocardial injury that is represented as a gradually decrease in GLS and GLS-s. These parameters may provide new insight for monitoring risk and therapy in patients with breast cancer. EVIDENCE LEVEL 2. TECHNICAL EFFICACY Stage 1.
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Affiliation(s)
- Yue Zheng
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Hui Liu
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Li Zhao
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Shu Guan
- Department of Breast Surgery, The First Hospital of China Medical University, Shenyang, China
| | - Huaibi Huo
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Han Li
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Jie Guo
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, Shenyang, China
| | - Xin Peng
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Yuetong Hao
- Department of Breast Surgery, Cancer Hospital of China Medical University, Shenyang, China
- Department of Breast Surgery, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Shiqi Jin
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xu Dai
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
- Liaoning University of Traditional Chinese Medicine, Shenyang, China
| | - Ting Liu
- Department of Radiology, The First Hospital of China Medical University, Shenyang, China
| | - Xinfeng Zhang
- Department of Breast Surgery, Cancer Hospital of China Medical University, Shenyang, China
- Department of Breast Surgery, Liaoning Cancer Hospital & Institute, Shenyang, China
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Zhang J, Jin H. A case of Brugada phenocopy alteration induced by immune checkpoint inhibitors. J Electrocardiol 2023; 81:269-271. [PMID: 37924699 DOI: 10.1016/j.jelectrocard.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 10/16/2023] [Accepted: 10/16/2023] [Indexed: 11/06/2023]
Abstract
Immunotherapy has shown remarkable efficacy in various cancer treatments. However, enhanced T-cell immune surveillance can lead to aberrant immune responses, resulting in severe immune checkpoint inhibitor-related adverse events. This is a case report of a patient previously treated with immune checkpoint inhibitors who presented with ST-segment elevation without abnormal troponin and cardiac enzyme spectrum test results. Cardiac toxicity of immune checkpoint inhibitors mainly manifests as acute immune-mediated myocarditis. While Brugada phenocopy is commonly caused by fever, electrolyte abnormalities, tricyclic/tetracyclic antidepressants, and marijuana use, we suspect that it was induced by immune checkpoint inhibitors in the current case.
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Affiliation(s)
- Jianming Zhang
- Department of Electrocardiology, Shaoxing People's Hospital, Shaoxing, China
| | - Huayong Jin
- Department of Electrocardiology, Shaoxing People's Hospital, Shaoxing, China.
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Addison D, Neilan TG, Barac A, Scherrer-Crosbie M, Okwuosa TM, Plana JC, Reding KW, Taqueti VR, Yang EH, Zaha VG. Cardiovascular Imaging in Contemporary Cardio-Oncology: A Scientific Statement From the American Heart Association. Circulation 2023; 148:1271-1286. [PMID: 37732422 DOI: 10.1161/cir.0000000000001174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Advances in cancer therapeutics have led to dramatic improvements in survival, now inclusive of nearly 20 million patients and rising. However, cardiovascular toxicities associated with specific cancer therapeutics adversely affect the outcomes of patients with cancer. Advances in cardiovascular imaging have solidified the critical role for robust methods for detecting, monitoring, and prognosticating cardiac risk among patients with cancer. However, decentralized evaluations have led to a lack of consensus on the optimal uses of imaging in contemporary cancer treatment (eg, immunotherapy, targeted, or biological therapy) settings. Similarly, available isolated preclinical and clinical studies have provided incomplete insights into the effectiveness of multiple modalities for cardiovascular imaging in cancer care. The aims of this scientific statement are to define the current state of evidence for cardiovascular imaging in the cancer treatment and survivorship settings and to propose novel methodological approaches to inform the optimal application of cardiovascular imaging in future clinical trials and registries. We also propose an evidence-based integrated approach to the use of cardiovascular imaging in routine clinical settings. This scientific statement summarizes and clarifies available evidence while providing guidance on the optimal uses of multimodality cardiovascular imaging in the era of emerging anticancer therapies.
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Gamble DT, Ross J, Khan H, Unger A, Cheyne L, Rudd A, Saunders F, Srivanasan J, Kamya S, Horgan G, Hannah A, Baliga S, Tocchetti CG, Urquhart G, Linke WA, Masannat Y, Mustafa A, Fuller M, Elsberger B, Sharma R, Dawson D. Impaired Cardiac and Skeletal Muscle Energetics Following Anthracycline Therapy for Breast Cancer. Circ Cardiovasc Imaging 2023; 16:e015782. [PMID: 37847761 PMCID: PMC10581415 DOI: 10.1161/circimaging.123.015782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/12/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Anthracycline-related cardiac toxicity is a recognized consequence of cancer therapies. We assess resting cardiac and skeletal muscle energetics and myocyte, sarcomere, and mitochondrial integrity in patients with breast cancer receiving epirubicin. METHODS In a prospective, mechanistic, observational, longitudinal study, we investigated chemotherapy-naive patients with breast cancer receiving epirubicin versus sex- and age-matched healthy controls. Resting energetic status of cardiac and skeletal muscle (phosphocreatine/gamma ATP and inorganic phosphate [Pi]/phosphocreatine, respectively) was assessed with 31P-magnetic resonance spectroscopy. Cardiac function and tissue characterization (magnetic resonance imaging and 2D-echocardiography), cardiac biomarkers (serum NT-pro-BNP and high-sensitivity troponin I), and structural assessments of skeletal muscle biopsies were obtained. All study assessments were performed before and after chemotherapy. RESULTS Twenty-five female patients with breast cancer (median age, 53 years) received a mean epirubicin dose of 304 mg/m2, and 25 age/sex-matched controls were recruited. Despite comparable baseline cardiac and skeletal muscle energetics with the healthy controls, after chemotherapy, patients with breast cancer showed a reduction in cardiac phosphocreatine/gamma ATP ratio (2.0±0.7 versus 1.1±0.5; P=0.001) and an increase in skeletal muscle Pi/phosphocreatine ratio (0.1±0.1 versus 0.2±0.1; P=0.022). This occurred in the context of increases in left ventricular end-systolic and end-diastolic volumes (P=0.009 and P=0.008, respectively), T1 and T2 mapping (P=0.001 and P=0.028, respectively) but with preserved left ventricular ejection fraction, mass and global longitudinal strain, and no change in cardiac biomarkers. There was preservation of the mitochondrial copy number in skeletal muscle biopsies but a significant increase in areas of skeletal muscle degradation (P=0.001) in patients with breast cancer following chemotherapy. Patients with breast cancer demonstrated a reduction in skeletal muscle sarcomere number from the prechemotherapy stage compared with healthy controls (P=0.013). CONCLUSIONS Contemporary doses of epirubicin for breast cancer treatment result in a significant reduction of cardiac and skeletal muscle high-energy 31P-metabolism alongside structural skeletal muscle changes. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT04467411.
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Affiliation(s)
- David T. Gamble
- Cardiology Research Group, Aberdeen Cardiovascular and Diabetes Centre, School of Medicine and Dentistry, University of Aberdeen, United Kingdom (D.T.G., J.R., H.K., L.C., A.R., F.S., J.S., S.K., D.D.)
| | - James Ross
- Cardiology Research Group, Aberdeen Cardiovascular and Diabetes Centre, School of Medicine and Dentistry, University of Aberdeen, United Kingdom (D.T.G., J.R., H.K., L.C., A.R., F.S., J.S., S.K., D.D.)
| | - Hilal Khan
- Cardiology Research Group, Aberdeen Cardiovascular and Diabetes Centre, School of Medicine and Dentistry, University of Aberdeen, United Kingdom (D.T.G., J.R., H.K., L.C., A.R., F.S., J.S., S.K., D.D.)
| | - Andreas Unger
- Institute of Physiology II, University of Münster, Germany (A.U., W.A.L.)
| | - Lesley Cheyne
- Cardiology Research Group, Aberdeen Cardiovascular and Diabetes Centre, School of Medicine and Dentistry, University of Aberdeen, United Kingdom (D.T.G., J.R., H.K., L.C., A.R., F.S., J.S., S.K., D.D.)
| | - Amelia Rudd
- Cardiology Research Group, Aberdeen Cardiovascular and Diabetes Centre, School of Medicine and Dentistry, University of Aberdeen, United Kingdom (D.T.G., J.R., H.K., L.C., A.R., F.S., J.S., S.K., D.D.)
| | - Fiona Saunders
- Cardiology Research Group, Aberdeen Cardiovascular and Diabetes Centre, School of Medicine and Dentistry, University of Aberdeen, United Kingdom (D.T.G., J.R., H.K., L.C., A.R., F.S., J.S., S.K., D.D.)
| | - Janaki Srivanasan
- Cardiology Research Group, Aberdeen Cardiovascular and Diabetes Centre, School of Medicine and Dentistry, University of Aberdeen, United Kingdom (D.T.G., J.R., H.K., L.C., A.R., F.S., J.S., S.K., D.D.)
| | - Sylvia Kamya
- Cardiology Research Group, Aberdeen Cardiovascular and Diabetes Centre, School of Medicine and Dentistry, University of Aberdeen, United Kingdom (D.T.G., J.R., H.K., L.C., A.R., F.S., J.S., S.K., D.D.)
| | - Graham Horgan
- Biomathematics and Statistics Scotland, Aberdeen (G.H.)
| | - Andrew Hannah
- Department of Cardiology National Health Service (NHS) Grampian (A.H.), Aberdeen Royal Infirmary, Foresterhill, Scotland, United Kingdom
| | - Santosh Baliga
- Department of Trauma and Orthopaedic Surgery (S.B.), Aberdeen Royal Infirmary, Foresterhill, Scotland, United Kingdom
| | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences (DISMET), Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center of Clinical and Translational Sciences (CIRCET), Interdepartmental Hypertension Research Center (CIRIAPA), Federico II University, Naples, Italy (C.G.T.)
| | - Gordon Urquhart
- Department of Oncology NHS Grampian (G.U., R.S.), Aberdeen Royal Infirmary, Foresterhill, Scotland, United Kingdom
| | - Wolfgang A. Linke
- Institute of Physiology II, University of Münster, Germany (A.U., W.A.L.)
| | - Yazan Masannat
- Department of Breast Surgery NHS Grampian (Y.M., A.M., M.F., B.E.), Aberdeen Royal Infirmary, Foresterhill, Scotland, United Kingdom
| | - Ahmed Mustafa
- Department of Breast Surgery NHS Grampian (Y.M., A.M., M.F., B.E.), Aberdeen Royal Infirmary, Foresterhill, Scotland, United Kingdom
| | - Mairi Fuller
- Department of Breast Surgery NHS Grampian (Y.M., A.M., M.F., B.E.), Aberdeen Royal Infirmary, Foresterhill, Scotland, United Kingdom
| | - Beatrix Elsberger
- Department of Breast Surgery NHS Grampian (Y.M., A.M., M.F., B.E.), Aberdeen Royal Infirmary, Foresterhill, Scotland, United Kingdom
| | - Ravi Sharma
- Department of Oncology NHS Grampian (G.U., R.S.), Aberdeen Royal Infirmary, Foresterhill, Scotland, United Kingdom
| | - Dana Dawson
- Cardiology Research Group, Aberdeen Cardiovascular and Diabetes Centre, School of Medicine and Dentistry, University of Aberdeen, United Kingdom (D.T.G., J.R., H.K., L.C., A.R., F.S., J.S., S.K., D.D.)
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Lisi C, Catapano F, Rondi P, Figliozzi S, Lo Monaco M, Brilli F, Monti L, Francone M. Multimodality imaging in cardio-oncology: the added value of CMR and CCTA. Br J Radiol 2023; 96:20220999. [PMID: 37493228 PMCID: PMC10546447 DOI: 10.1259/bjr.20220999] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 07/27/2023] Open
Abstract
During the last 30 years, we have assisted to a great implementation in anticancer treatment with a subsequent increase of cancer survivors and decreased mortality. This has led to an ongoing interest about the possible therapy-related side-effects and their management to better guide patients therapy and surveillance in the chronic and long-term setting. As a consequence cardio-oncology was born, involving several different specialties, among which radiology plays a relevant role. Till the end of August 2022, when European Society of Cardiology (ESC) developed the first guidelines on cardio-oncology, no general indications existed to guide diagnosis and treatment of cancer therapy-related cardiovascular toxicity (CTR-CVT). They defined multimodality imaging role in primary and secondary prevention strategies, cancer treatment surveillance and early CTR-CVT identification and management. Cardiac computed tomography angiography (CCTA) has acquired a central role in coronary assessment, as far as coronary artery disease (CAD) exclusion is concerned; but on the side of this well-known application, it also started to be considered in left ventricular function evaluation, interstitial fibrosis quantification and cardiac perfusion studies. Cardiac magnetic resonance (CMR), instead, has been acknowledged as the gold standard alternative to trans-thoracic echocardiography (TTE) poor acoustic window in quantification of heart function and strain modifications, as well as pre- and post-contrast tissue characterization by means of T1-T2 mapping, early Gadolinium enhancement (EGE), late Gadolinium enhancement (LGE) and extracellular volume (ECV) evaluation. Our review is intended to provide a focus on the actual role of CMR and CCTA in the setting of a better understanding of cardiotoxicity and to draw some possible future directions of cardiac imaging in this field, starting from the recently published ESC guidelines.
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Affiliation(s)
- Costanza Lisi
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
| | | | - Paolo Rondi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Stefano Figliozzi
- IRCCS Humanitas Research Hospital, via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Maria Lo Monaco
- Cardiology Clinical Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
| | - Federica Brilli
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy
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Alexandraki A, Papageorgiou E, Zacharia M, Keramida K, Papakonstantinou A, Cipolla CM, Tsekoura D, Naka K, Mazzocco K, Mauri D, Tsiknakis M, Manikis GC, Marias K, Marcou Y, Kakouri E, Konstantinou I, Daniel M, Galazi M, Kampouroglou E, Ribnikar D, Brown C, Karanasiou G, Antoniades A, Fotiadis D, Filippatos G, Constantinidou A. New Insights in the Era of Clinical Biomarkers as Potential Predictors of Systemic Therapy-Induced Cardiotoxicity in Women with Breast Cancer: A Systematic Review. Cancers (Basel) 2023; 15:3290. [PMID: 37444400 PMCID: PMC10340234 DOI: 10.3390/cancers15133290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/09/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
Cardiotoxicity induced by breast cancer therapies is a potentially serious complication associated with the use of various breast cancer therapies. Prediction and better management of cardiotoxicity in patients receiving chemotherapy is of critical importance. However, the management of cancer therapy-related cardiac dysfunction (CTRCD) lacks clinical evidence and is based on limited clinical studies. AIM To provide an overview of existing and potentially novel biomarkers that possess a promising predictive value for the early and late onset of CTRCD in the clinical setting. METHODS A systematic review of published studies searching for promising biomarkers for the prediction of CTRCD in patients with breast cancer was undertaken according to PRISMA guidelines. A search strategy was performed using PubMed, Google Scholar, and Scopus for the period 2013-2023. All subjects were >18 years old, diagnosed with breast cancer, and received breast cancer therapies. RESULTS The most promising biomarkers that can be used for the development of an alternative risk cardiac stratification plan for the prediction and/or early detection of CTRCD in patients with breast cancer were identified. CONCLUSIONS We highlighted the new insights associated with the use of currently available biomarkers as a standard of care for the management of CTRCD and identified potentially novel clinical biomarkers that could be further investigated as promising predictors of CTRCD.
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Affiliation(s)
- Alexia Alexandraki
- A.G. Leventis Clinical Trials Unit, Bank of Cyprus Oncology Centre, 32 Acropoleos Avenue, Nicosia 2006, Cyprus; (E.P.); (M.Z.)
| | - Elisavet Papageorgiou
- A.G. Leventis Clinical Trials Unit, Bank of Cyprus Oncology Centre, 32 Acropoleos Avenue, Nicosia 2006, Cyprus; (E.P.); (M.Z.)
| | - Marina Zacharia
- A.G. Leventis Clinical Trials Unit, Bank of Cyprus Oncology Centre, 32 Acropoleos Avenue, Nicosia 2006, Cyprus; (E.P.); (M.Z.)
| | - Kalliopi Keramida
- 2nd Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece;
- Cardiology Department, General Anti-Cancer Oncological Hospital, Agios Savvas, 11522 Athens, Greece
| | - Andri Papakonstantinou
- Department of Oncology-Pathology, Karolinska Institute, 17176 Stockholm, Sweden;
- Department for Breast, Endocrine Tumours and Sarcoma, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Carlo M. Cipolla
- Cardioncology and Second Opinion Division, European Institute of Oncology (IEO), IRCCS, Via Ripamonti 435, 20141 Milan, Italy;
| | - Dorothea Tsekoura
- 2nd Department of Surgery, Aretaieio University Hospital, National and Kapodistrian University of Athens, 76 Vas. Sofias Av., 11528 Athens, Greece; (D.T.); (E.K.)
| | - Katerina Naka
- 2nd Cardiology Department, University of Ioannina Medical School, 45110 Ioannina, Greece;
| | - Ketti Mazzocco
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, 20139 Milan, Italy;
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Davide Mauri
- Department of Medical Oncology, University of Ioannina, 45110 Ioannina, Greece;
| | - Manolis Tsiknakis
- Department of Electrical and Computer Engineering, Hellenic Mediterranean University, 71410 Heraklion, Greece; (M.T.); (K.M.)
- Computational BioMedicine Laboratory (CBML), Institute of Computer Science, Foundation for Research and Technology Hellas (FORTH), 70013 Heraklion, Greece;
| | - Georgios C. Manikis
- Computational BioMedicine Laboratory (CBML), Institute of Computer Science, Foundation for Research and Technology Hellas (FORTH), 70013 Heraklion, Greece;
| | - Kostas Marias
- Department of Electrical and Computer Engineering, Hellenic Mediterranean University, 71410 Heraklion, Greece; (M.T.); (K.M.)
- Computational BioMedicine Laboratory (CBML), Institute of Computer Science, Foundation for Research and Technology Hellas (FORTH), 70013 Heraklion, Greece;
| | - Yiola Marcou
- Department of Medical Oncology, Bank of Cyprus Oncology Centre, 32 Acropoleos Avenue, Nicosia 2006, Cyprus; (Y.M.); (E.K.); (I.K.); (M.G.)
| | - Eleni Kakouri
- Department of Medical Oncology, Bank of Cyprus Oncology Centre, 32 Acropoleos Avenue, Nicosia 2006, Cyprus; (Y.M.); (E.K.); (I.K.); (M.G.)
| | - Ifigenia Konstantinou
- Department of Medical Oncology, Bank of Cyprus Oncology Centre, 32 Acropoleos Avenue, Nicosia 2006, Cyprus; (Y.M.); (E.K.); (I.K.); (M.G.)
| | - Maria Daniel
- Department of Radiation Oncology, Bank of Cyprus Oncology Centre, 32 Acropoleos Avenue, Nicosia 2006, Cyprus;
| | - Myria Galazi
- Department of Medical Oncology, Bank of Cyprus Oncology Centre, 32 Acropoleos Avenue, Nicosia 2006, Cyprus; (Y.M.); (E.K.); (I.K.); (M.G.)
| | - Effrosyni Kampouroglou
- 2nd Department of Surgery, Aretaieio University Hospital, National and Kapodistrian University of Athens, 76 Vas. Sofias Av., 11528 Athens, Greece; (D.T.); (E.K.)
| | - Domen Ribnikar
- Division of Medical Oncology, Institute of Oncology Ljubljana, Faculty of Medicine, University of Ljubljana, Zaloska Cesta 2, 1000 Ljubljana, Slovenia;
| | - Cameron Brown
- Translational Medicine, Stremble Ventures Ltd., 59 Christaki Kranou, Limassol 4042, Cyprus;
| | - Georgia Karanasiou
- Biomedical Research Institute, Foundation for Research and Technology, Hellas, 45500 Ioannina, Greece;
| | - Athos Antoniades
- Research and Development, Stremble Ventures Ltd., 59 Christaki Kranou, Limassol 4042, Cyprus;
| | - Dimitrios Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, 45110 Ioannina, Greece;
| | - Gerasimos Filippatos
- Cardio-Oncology Clinic, Heart Failure Unit, Department of Cardiology, National and Kapodistrian University of Athens Medical School, Athens University Hospital Attikon, 11527 Athens, Greece;
| | - Anastasia Constantinidou
- Department of Medical Oncology, Bank of Cyprus Oncology Centre, 32 Acropoleos Avenue, Nicosia 2006, Cyprus; (Y.M.); (E.K.); (I.K.); (M.G.)
- School of Medicine, University of Cyprus, Panepistimiou 1, Aglantzia, Nicosia 2408, Cyprus
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Cheng S, Wang J, Wang Y, Qi L, Li F, Liu J, Chen J, Fan Y, Xie L. Longitudinal assessment of cardiac parameters through MRI in breast cancer patients treated with anti-HER2 therapy. Eur Radiol Exp 2023; 7:22. [PMID: 37183212 PMCID: PMC10183380 DOI: 10.1186/s41747-023-00338-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/10/2023] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND We evaluated the early changes in left ventricular (LV) volumetric, functional, and tissue characteristics in human epidermal growth factor receptor 2 (HER2)-positive breast cancer patients treated with trastuzumab and/or pertuzumab at cardiac magnetic resonance imaging (MRI). METHODS HER2-positive breast cancer patients undergoing planned anti-HER2 therapy and nonanthracycline-based chemotherapy were enrolled and subdivided into dual anti-HER2 (trastuzumab plus pertuzumab) group and trastuzumab group. Cardiac MRI was performed before treatment and three months after starting, covering ventricular volumes, cardiac function, systolic myocardial strain, myocardial oedema, and T1 and T2 relaxation times. Cardiac dysfunction was primarily defined as a > 10% reduction in LV ejection fraction (LVEF) to < 55% and/or a > 15% global longitudinal strain (GLS) change at the follow-up MRI examination. RESULTS Twenty-four HER2-positive patients were evaluated (16 in the dual anti-HER2 group, 8 in the trastuzumab group). Six patients developed cardiac dysfunction at follow-up, five of them in the dual anti-HER2 group. One patient developed symptomatic heart failure, and five patients developed asymptomatic cardiac dysfunction. Patients displayed significantly decreased systolic function and increased T1 and T2 relaxation time at follow-up (p ≤ 0.031). Systolic dysfunction remained significant in the dual anti-HER2 group. The decrease in GLS in the trastuzumab group was not significant (p = 0.169). T1 and T2 relaxation times tended to increase, but this was not significant at subgroup analysis. CONCLUSIONS Cardiac MRI scans showed frequent signs of subclinical cardiotoxicity after short-term anti-HER2 therapy and nonanthracycline-based chemotherapy; the effect was slightly stronger in patients treated with dual therapy. KEY POINTS • A frequent subclinical cardiotoxicity was detected by cardiac magnetic resonance imaging after short-term anti-human epidermal growth factor receptor 2 (HER2) therapy. • The change in myocardial strain was more marked in patients treated with dual (trastuzumab plus pertuzumab) than with trastuzumab only anti-HER2 therapy. • Cardiotoxicity surveillance through MRI is an interesting option particularly in patients treated with dual anti-HER2 therapy.
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Affiliation(s)
- Sainan Cheng
- Department of Diagnostic Radiology, National Cancer Center / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Jianwei Wang
- Department of Diagnostic Radiology, National Cancer Center / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
| | - Yawen Wang
- Department of Diagnostic Radiology, National Cancer Center / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Linlin Qi
- Department of Diagnostic Radiology, National Cancer Center / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Fenglan Li
- Department of Diagnostic Radiology, National Cancer Center / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Jianing Liu
- Department of Diagnostic Radiology, National Cancer Center / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Jiaqi Chen
- Department of Diagnostic Radiology, National Cancer Center / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, #17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Yang Fan
- MR Research China, GE Healthcare, Beijing, China
| | - Lizhi Xie
- MR Research China, GE Healthcare, Beijing, China
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10
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Cannizzaro MT, Inserra MC, Passaniti G, Celona A, D'Angelo T, Romeo P, Basile A. Role of advanced cardiovascular imaging in chemotherapy-induced cardiotoxicity. Heliyon 2023; 9:e15226. [PMID: 37095987 PMCID: PMC10121465 DOI: 10.1016/j.heliyon.2023.e15226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023] Open
Abstract
The development of cardiotoxicity induced by cancer treatments has emerged as a significant clinical problem, both in the short run, as it may influence drug administration in chemotherapeutic protocols, and in the long run, because it may determine adverse cardiovascular outcomes in survivors of various malignant diseases. Therefore, early detection of anticancer drug-related cardiotoxicity is an important clinical target to improve prevention of adverse effects and patient care. Today, echocardiography is the first-line cardiac imaging techniques used for identifying cardiotoxicity. Cardiac dysfunction, clinical and subclinical, is generally diagnosed by the reduction of left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). However, myocardial injury detected by echocardiography is preceded by other alterations, such as myocardial perfusion and mitochondrial and metabolic dysfunction, that can only be recognized by second-level imaging techniques, like cardiac magnetic resonance (CMR) and nuclear imaging, which, using targeted radiotracers, may help to provide information on the specific mechanisms of cardiotoxicity. In this review, we focus on the current and emerging role of CMR, as a critical diagnostic tool of cardiotoxicity in the very early phase, due to its availability and because it allows the contemporary detection of functional alterations, tissue alterations (mainly performed using T1, T2 mapping with the evaluation of extracellular volume-ECV) and perfusional alteration (evaluated with rest-stress perfusion) and, in the next future, even metabolic changes. Moreover, in the subsequent future, the use of Artificial Intelligence and big data on imaging parameters (CT, CMR) and oncoming molecular imaging datasets, including differences for gender and countries, may help predict cardiovascular toxicity at its earliest stages, avoiding its progression, with precise tailoring of patients' diagnostic and therapeutic pathways.
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Affiliation(s)
| | | | | | | | - Tommaso D'Angelo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Ospital “Policlinico G. Martino”, Messina, Italy
| | - Placido Romeo
- Radiology Department of AO “San Marco”, A.U.O. Policlinico “G.Rodolico-San Marco”, Catania, Italy
| | - Antonio Basile
- University of Catania, Department of Surgical and Medical Sciences and Advanced Technologies ‘G.F. Ingrassia’, Italy
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Ibrahim ESH, Sosa A, Brown SA, An D, Klawikowski S, Baker J, Bergom C. Myocardial Contractility Pattern Characterization in Radiation-Induced Cardiotoxicity Using Magnetic Resonance Imaging: A Pilot Study with ContractiX. Tomography 2022; 9:36-49. [PMID: 36648991 PMCID: PMC9844312 DOI: 10.3390/tomography9010004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
Radiation therapy (RT) plays an integral role in treating thoracic cancers, despite the risk of radiation-induced cardiotoxicity. We hypothesize that our newly developed magnetic resonance imaging (MRI)-based contractility index (ContractiX) is a sensitive marker for early detection of RT-induced cardiotoxicity in a preclinical rat model of thoracic cancer RT. Adult salt-sensitive rats received image-guided heart RT and were imaged with MRI at 8 weeks and 10 weeks post-RT or sham. The MRI exam included cine and tagging sequences to measure left-ventricular ejection fraction (LVEF), mass, myocardial strain, and ContractiX. Furthermore, ventricular torsion, diastolic strain rate, and mechanical dyssynchrony were measured. Statistical analyses were performed between the sham, 8 weeks post-RT, and 10 weeks post-RT MRI parameters. The results showed that both LVEF and myocardial mass increased post-RT. Peak systolic strain and ContractiX significantly decreased post-RT, with a more relative reduction in ContractiX compared to strain. ContractiX showed an inverse nonlinear relationship with LVEF and continuously decreased with time post-RT. While early diastolic strain rate and mechanical dyssynchrony significantly changed post-RT, ventricular torsion changes were not significant post-RT. In conclusion, ContractiX measured via non-contrast MRI is a sensitive early marker for the detection of subclinical cardiac dysfunction post-RT, and it is superior to other MRI cardiac measures.
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Affiliation(s)
- El-Sayed H. Ibrahim
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
- Correspondence:
| | - Antonio Sosa
- Department of Radiology, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Sherry-Ann Brown
- Department of Medicine, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Dayeong An
- Department of Biomedical Engineering, Marquette University, 1250 W Wisconsin Ave, Milwaukee, WI 53233, USA
| | - Slade Klawikowski
- Department of Radiation Oncology, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - John Baker
- Department of Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA
| | - Carmen Bergom
- Department of Radiation Oncology, Washington University, 1 Brookings Dr, St. Louis, MO 63130, USA
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12
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Harries I, Biglino G, Ford K, Nelson M, Rego G, Srivastava P, Williams M, Berlot B, De Garate E, Baritussio A, Liang K, Baquedano M, Chavda N, Lawton C, Shearn A, Otton S, Lowry L, Nightingale AK, Carlos Plana J, Marks D, Emanueli C, Bucciarelli-Ducci C. Prospective multiparametric CMR characterization and MicroRNA profiling of anthracycline cardiotoxicity: A pilot translational study. IJC HEART & VASCULATURE 2022; 43:101134. [PMID: 36389268 PMCID: PMC9647504 DOI: 10.1016/j.ijcha.2022.101134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/14/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022]
Abstract
Background Anthracycline cardiotoxicity is a significant clinical challenge. Biomarkers to improve risk stratification and identify early cardiac injury are required. Objectives The purpose of this pilot study was to prospectively characterize anthracycline cardiotoxicity using cardiovascular magnetic resonance (CMR), echocardiography and MicroRNAs (MiRNAs), and identify baseline predictors of LVEF recovery. Methods Twenty-four patients (age 56 range 18-75 years; 42 % female) with haematological malignancy scheduled to receive anthracycline chemotherapy (median dose 272 mg/m2 doxorubicin equivalent) were recruited and evaluated at three timepoints (baseline, completion of chemotherapy, and 6 months after completion of chemotherapy) with multiparametric 1.5 T CMR, echocardiography and circulating miRNAs sequencing. Results Seventeen complete datasets were obtained. CMR left ventricular ejection fraction (LVEF) fell significantly between baseline and completion of chemotherapy (61 ± 3 vs 53 ± 3 %, p < 0.001), before recovering significantly at 6-month follow-up (55 ± 3 %, p = 0.018). Similar results were observed for 3D echocardiography-derived LVEF and CMR-derived longitudinal, circumferential and radial feature-tracking strain. Patients were divided into tertiles according to LVEF recovery (poor recovery, partial recovery, good recovery). CMR-derived mitral annular plane systolic excursion (MAPSE) was significantly different at baseline in patients exhibiting poor LVEF recovery (11.7 ± 1.5 mm) in comparison to partial recovery (13.7 ± 2.7 mm), and good recovery (15.7 ± 3.1 mm; p = 0.028). Furthermore, baseline miRNA-181-5p and miRNA-221-3p expression were significantly higher in this group. T2 mapping increased significantly on completion of chemotherapy compared to baseline (54.0 ± 4.6 to 57.8 ± 4.9 ms, p = 0.001), but was not predictive of LVEF recovery. No changes to LV mass, extracellular volume fraction, T1 mapping or late gadolinium enhancement were observed. Conclusions Baseline CMR-derived MAPSE, circulating miRNA-181-5p, and miRNA-221-3p were associated with poor recovery of LVEF 6 months after completion of anthracycline chemotherapy, suggesting their potential predictive role in this context. T2 mapping increased significantly on completion of chemotherapy but was not predictive of LVEF recovery.
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Key Words
- CMR, cardiovascular magnetic resonance
- Cancer therapeutics-related cardiac dysfunction
- Cardio-oncology
- Cardiovascular magnetic resonance
- ECV, extracellular volume
- LAVi, left atrial volume indexed
- LGE, late gadolinium enhancement
- LV, left ventricle
- LVEF, left ventricular ejection fraction
- MAPSE, mitral annular plane systolic excursion
- MiRNAs, MicroRNAs
- iLVEDV, left ventricular end-diastolic volume indexed
- iLVESV, indexed left ventricular end-systolic volume indexed
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Affiliation(s)
- Iwan Harries
- Bristol Heart Institute, Bristol Medical School, University Hospitals Bristol, Bristol, UK
| | - Giovanni Biglino
- Bristol Heart Institute, Bristol Medical School, University Hospitals Bristol, Bristol, UK
- Myocardial Function – National Heart and Lung Institute, Imperial College London, London, UK
- NIHR Bristol Biomedical Research Centre, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Kerrie Ford
- Bristol Heart Institute, Bristol Medical School, University Hospitals Bristol, Bristol, UK
| | - Martin Nelson
- Bristol Heart Institute, Bristol Medical School, University Hospitals Bristol, Bristol, UK
| | - Gui Rego
- Bristol Heart Institute, Bristol Medical School, University Hospitals Bristol, Bristol, UK
| | - Prashant Srivastava
- Myocardial Function – National Heart and Lung Institute, Imperial College London, London, UK
| | - Matthew Williams
- Bristol Heart Institute, Bristol Medical School, University Hospitals Bristol, Bristol, UK
| | - Bostjan Berlot
- Bristol Heart Institute, Bristol Medical School, University Hospitals Bristol, Bristol, UK
| | - Estefania De Garate
- Bristol Heart Institute, Bristol Medical School, University Hospitals Bristol, Bristol, UK
| | - Anna Baritussio
- Bristol Heart Institute, Bristol Medical School, University Hospitals Bristol, Bristol, UK
| | - Kate Liang
- Bristol Heart Institute, Bristol Medical School, University Hospitals Bristol, Bristol, UK
| | - Mai Baquedano
- NIHR Bristol Biomedical Research Centre, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Nikesh Chavda
- Bristol Heamatology and Oncology Centre, University Hospitals Bristol NHS Trust, Bristol United Kingdom, UK
| | - Christopher Lawton
- Bristol Heart Institute, Bristol Medical School, University Hospitals Bristol, Bristol, UK
| | - Andrew Shearn
- Bristol Heart Institute, Bristol Medical School, University Hospitals Bristol, Bristol, UK
| | | | | | - Angus K. Nightingale
- Bristol Heart Institute, Bristol Medical School, University Hospitals Bristol, Bristol, UK
| | | | - David Marks
- Bristol Heamatology and Oncology Centre, University Hospitals Bristol NHS Trust, Bristol United Kingdom, UK
| | - Costanza Emanueli
- Myocardial Function – National Heart and Lung Institute, Imperial College London, London, UK
- NIHR Bristol Biomedical Research Centre, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Chiara Bucciarelli-Ducci
- Royal Brompton and Harefield Hospitals, Guys’ and St Thomas NHS Foundation Trust, London
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, Kings College, London
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13
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New advances in medical imaging technology for the evaluation of anthracycline-induced cardiotoxicity. Chin Med J (Engl) 2022; 135:1883-1885. [PMID: 36195994 PMCID: PMC9521788 DOI: 10.1097/cm9.0000000000002123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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14
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Wei X, Lin L, Zhang G, Zhou X. Cardiovascular Magnetic Resonance Imaging in the Early Detection of Cardiotoxicity Induced by Cancer Therapies. Diagnostics (Basel) 2022; 12:diagnostics12081846. [PMID: 36010197 PMCID: PMC9406931 DOI: 10.3390/diagnostics12081846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 11/16/2022] Open
Abstract
The significant progress in cancer treatment, including chemotherapy, immunotherapy, radiotherapy, and combination therapies, has led to higher long-term survival rates in cancer patients, while the cardiotoxicity caused by cancer treatment has become increasingly prominent. Cardiovascular magnetic resonance (CMR) is a non-invasive comprehensive imaging modality that provides not only anatomical information, but also tissue characteristics and cardiometabolic and energetic assessment, leading to its increased use in the early identification of cardiotoxicity, and is of major importance in improving the survival rate of cancer patients. This review focused on CMR techniques, including myocardial strain analysis, T1 mapping, T2 mapping, and extracellular volume fraction (ECV) calculation in the detection of early myocardial injury induced by cancer therapies. We summarized the existing studies and ongoing clinical trials using CMR for the assessment of subclinical ventricular dysfunction and myocardial changes at the tissue level. The main focus was to explore the potential of clinical and preclinical CMR techniques for continuous non-invasive monitoring of myocardial toxicity associated with cancer therapy.
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15
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Borgonovo G, Vettus E, Greco A, Leo LA, Faletra FF, Klersy C, Curti M, Valli M. Early Detection of Cardiotoxicity From Systemic and Radiation Therapy in Patients With Breast Cancer: Protocol for a Multi-Institutional Prospective Study. JMIR Res Protoc 2022; 11:e31887. [PMID: 35451989 PMCID: PMC9073600 DOI: 10.2196/31887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/08/2021] [Accepted: 11/27/2021] [Indexed: 11/30/2022] Open
Abstract
Background The incidence of breast cancer is rising worldwide. Recent advances in systemic and local treatments have significantly improved survival rates of patients having early breast cancer. In the last decade, great attention has been paid to the prevention and early detection of cardiotoxicity induced by breast cancer treatments. Systemic therapy-related cardiac toxicities have been extensively studied. Radiotherapy, an essential component of breast cancer treatment, can also increase the risk of heart diseases. Consequently, it is important to balance the expected benefits of cancer treatment with cardiovascular risk and to identify strategies to prevent cardiotoxicity and improve long-term outcomes and quality of life for these patients. Objective This CardioTox Breast study aims to investigate the use of cardiac imaging, based on cardiac magnetic resonance and echocardiography, and to identify associated circulating biomarkers to assess early tissue changes in chemo-induced and radiation-induced cardiotoxicity in the time window of 12 months after the end of radiotherapy in patients with breast cancer. Methods The CardioTox Breast trial is a multicenter observational prospective longitudinal study. We aim to enroll 150 women with stage I-III unilateral breast cancer, treated with breast conserving surgery, who planned to receive radiotherapy with or without systemic therapy. Baseline and follow-up data include cardiac measurements based on cardiac magnetic resonance imaging, echocardiography, and circulating biomarkers of cardiac toxicity. Results This study details the protocol of the CardioTox Breast trial. Recruitment started in September 2020. The results of this study will not be published until data are mature for the final analysis of the primary study end point. Conclusions The CardioTox Breast study is designed to investigate the effects of systemic and radiation therapy on myocardial function and structure, thus providing additional evidence on whether cardiac magnetic resonance is the optimal screening imaging for cardiotoxicity. Trial Registration ClinicalTrials.gov NCT04790266; https://clinicaltrials.gov/ct2/show/NCT04790266 International Registered Report Identifier (IRRID) DERR1-10.2196/31887
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Affiliation(s)
- Giulia Borgonovo
- Clinic of Radiation Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Elen Vettus
- Department of Oncology, East Tallinn Central Hospital, Tallinn, Estonia
| | - Alessandra Greco
- Division of Cardiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Laura Anna Leo
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | | | - Catherine Klersy
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Moreno Curti
- Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo, Pavia, Italy
| | - Mariacarla Valli
- Clinic of Radiation Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
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Pourier MS, Dull MM, Weijers G, Loonen J, Bellersen L, de Korte CL, Kapusta L, Mavinkurve-Groothuis AMC. Left ventricular dyssynchrony in long-term childhood cancer survivors treated with anthracyclines: a retrospective cross-sectional study. Int J Cardiovasc Imaging 2021; 37:3469-3475. [PMID: 34357522 PMCID: PMC8604879 DOI: 10.1007/s10554-021-02347-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/08/2021] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to investigate left ventricular contraction patterns in asymptomatic Childhood cancer survivors (CCS) using two-dimensional speckle tracking echocardiography (2DSTE). Left ventricular longitudinal and circumferential myocardial parameters were assessed using 2DSTE, in asymptomatic CCS and age matched healthy controls. Time to peak (T2P) systolic strain was quantified. Dyssynchrony index (DI) was measured by calculating the standard deviation of T2P systolic strain of six segments in each view. Difference between T2P systolic longitudinal strain of septal and lateral wall was also assessed as a parameter for dyssynchrony. We included 115 CCS with a median age of 17.2 years (range 5.6–39.5) and a median follow up of 11.3 years (range 4.9–29.5) and 119 controls. Conventional echocardiographic parameters and global longitudinal strain were significantly decreased in CCS compared to controls (p < 0.01 and p = 0.02, respectively). Dyssynchrony index did not differ between CCS and controls. There was a clinically insignificant smaller absolute difference between T2P systolic longitudinal of septal and lateral wall in CCS compared to controls. We showed no difference in longitudinal or circumferential left ventricular dyssynchrony in CCS compared to controls using 2DSTE. Future research should focus on assessing dyssynchrony in more segments and a larger CCS population, using both 2D and 3DSTE.
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Affiliation(s)
- Milanthy S Pourier
- Department of Pediatrics, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands. .,Department of Radiology and Nuclear Medicine, Medical UltraSound Imaging Centre (MUSIC), Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Myrthe M Dull
- Department of Pediatrics, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gert Weijers
- Department of Radiology and Nuclear Medicine, Medical UltraSound Imaging Centre (MUSIC), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jacqueline Loonen
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Louise Bellersen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chris L de Korte
- Department of Radiology and Nuclear Medicine, Medical UltraSound Imaging Centre (MUSIC), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Livia Kapusta
- Pediatric Cardiology Unit, Tel-Aviv Sourasky Medical Center, Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel.,Department of Pediatric Cardiology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, The Netherlands
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17
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Modi K, Joppa S, Chen KHA, Athwal PSS, Okasha O, Velangi PS, Hooks M, Nijjar PS, Blaes AH, Shenoy C. Myocardial damage assessed by late gadolinium enhancement on cardiovascular magnetic resonance imaging in cancer patients treated with anthracyclines and/or trastuzumab. Eur Heart J Cardiovasc Imaging 2021; 22:427-434. [PMID: 33211843 DOI: 10.1093/ehjci/jeaa279] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/24/2020] [Indexed: 01/03/2023] Open
Abstract
AIMS In cancer patients with cardiomyopathy related to anthracyclines and/or trastuzumab, data regarding late gadolinium enhancement (LGE) on cardiovascular magnetic resonance imaging are confusing. The prevalence ranges from 0% to 30% and the patterns are ill-defined. Whether treatment with anthracyclines and/or trastuzumab is associated with LGE is unclear. We aimed to investigate these topics in a large cohort of consecutive cancer patients with suspected cardiotoxicity from anthracyclines and/or trastuzumab. METHODS AND RESULTS We studied 298 patients, analysed the prevalence, patterns, and correlates of LGE, and determined their causes. We compared the findings with those from 100 age-matched cancer patients who received neither anthracyclines nor trastuzumab. Amongst those who received anthracyclines and/or trastuzumab, 31 (10.4%) had LGE. It had a wide range of extent (3.9-34.7%) and locations. An ischaemic pattern was present in 20/31 (64.5%) patients. There was an alternative explanation for the non-ischaemic LGE in 7/11 (63.6%) patients. In the age-matched patients who received neither anthracyclines nor trastuzumab, the prevalence of LGE was higher at 27.0%, while the extent of LGE and the proportion with ischaemic pattern were not different. CONCLUSION LGE was present in only a minority. Its patterns and locations did not fit into a single unique profile. It had alternative explanations in virtually all cases. Finally, LGE was also present in cancer patients who received neither anthracyclines nor trastuzumab. Therefore, treatment with anthracyclines and/or trastuzumab is unlikely to be associated with LGE. The absence of LGE can help distinguish anthracycline- and/or trastuzumab-related cardiomyopathy from unrelated cardiomyopathies.
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Affiliation(s)
- Kalpit Modi
- University of Minnesota Medical School, 420 Delaware Street SE, MMC 508, Minneapolis, MN 55455, USA
| | - Stephanie Joppa
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Ko-Hsuan Amy Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Pal Satyajit Singh Athwal
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Osama Okasha
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Pratik S Velangi
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Matthew Hooks
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Prabhjot S Nijjar
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Anne H Blaes
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Chetan Shenoy
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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18
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Narezkina A, Narayan HK, Zemljic-Harpf AE. Molecular mechanisms of anthracycline cardiovascular toxicity. Clin Sci (Lond) 2021; 135:1311-1332. [PMID: 34047339 PMCID: PMC10866014 DOI: 10.1042/cs20200301] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/07/2021] [Accepted: 05/11/2021] [Indexed: 12/21/2022]
Abstract
Anthracyclines are effective chemotherapeutic agents, commonly used in the treatment of a variety of hematologic malignancies and solid tumors. However, their use is associated with a significant risk of cardiovascular toxicities and may result in cardiomyopathy and heart failure. Cardiomyocyte toxicity occurs via multiple molecular mechanisms, including topoisomerase II-mediated DNA double-strand breaks and reactive oxygen species (ROS) formation via effects on the mitochondrial electron transport chain, NADPH oxidases (NOXs), and nitric oxide synthases (NOSs). Excess ROS may cause mitochondrial dysfunction, endoplasmic reticulum stress, calcium release, and DNA damage, which may result in cardiomyocyte dysfunction or cell death. These pathophysiologic mechanisms cause tissue-level manifestations, including characteristic histopathologic changes (myocyte vacuolization, myofibrillar loss, and cell death), atrophy and fibrosis, and organ-level manifestations including cardiac contractile dysfunction and vascular dysfunction. In addition, these mechanisms are relevant to current and emerging strategies to diagnose, prevent, and treat anthracycline-induced cardiomyopathy. This review details the established and emerging data regarding the molecular mechanisms of anthracycline-induced cardiovascular toxicity.
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Affiliation(s)
- Anna Narezkina
- Department of Medicine, Division of Cardiovascular Medicine, UCSD Cardiovascular Institute, University of California, San Diego
| | - Hari K. Narayan
- Department of Pediatrics, Division of Cardiology, University of California, San Diego
| | - Alice E. Zemljic-Harpf
- Veterans Affairs San Diego Healthcare System, San Diego, USA
- Department of Anesthesiology, University of California San Diego, La Jolla, California, USA
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19
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Role of cardiovascular magnetic resonance in early detection and treatment of cardiac dysfunction in oncology patients. Int J Cardiovasc Imaging 2021; 37:3003-3017. [PMID: 33982196 DOI: 10.1007/s10554-021-02271-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/02/2021] [Indexed: 12/26/2022]
Abstract
The purpose of this review is to provide an overview of the essential role that cardiovascular magnetic resonance (CMR) has in the field of cardio-oncology. Recent findings: CMR has been increasingly used for early identification of cancer therapy related cardiac dysfunction (CTRCD) due to its precision in detecting subtle changes in cardiac function and for myocardial tissue characterization. Summary: CMR is able to identify subclinical CTRCD in patients receiving potentially cardiotoxic chemotherapy and guide initiation of cardio protective therapy. Multiparametric analysis with myocardial strain, tissue characterization play a critical role in understanding important clinical questions in cardio-oncology.
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20
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Hoffman RK, Kim BJ, Shah PD, Carver J, Ky B, Ryeom S. Damage to cardiac vasculature may be associated with breast cancer treatment-induced cardiotoxicity. CARDIO-ONCOLOGY 2021; 7:15. [PMID: 33875012 PMCID: PMC8054404 DOI: 10.1186/s40959-021-00100-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 03/24/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Breast cancer is the most common female cancer worldwide. Effective therapies including doxorubicin and trastuzumab have improved survival, but are associated with a substantial risk of cardiovascular disease. Mechanisms underlying cancer treatment-induced cardiotoxicity (CTC) are poorly understood and have largely focused on cardiomyocyte damage, although other cellular populations in the heart such as the cardiac endothelium, may play an important role in cardiac damage. We treated a breast tumor-bearing mouse model with doxorubicin and trastuzumab to investigate the role of the cardiac endothelium in the development of CTC. METHODS Immune compromised mice were inoculated in the 4th mammary fat pad with human breast cancer cells overexpressing HER2 (BT474). When tumors were palpable, mice were treated weekly with doxorubicin (5 mg/kg) and trastuzumab (4 mg/kg). The cardiac phenotype of mice was assessed by echocardiography and histological evaluation of the heart. Cardiac vascular damage was assayed by in vivo permeability assays and primary cultures of murine cardiac endothelial cells were used to assay doxorubicin toxicity in vitro. RESULTS The growth of BT474 breast tumors in Balb/c Nude mice was suppressed upon treatment with doxorubicin and trastuzumab. Mice treated for 4 months with doxorubicin and trastuzumab maintained body weights, but demonstrated an echocardiographic phenotype consistent with preserved left ventricular (LV) ejection fraction, decreased LV mass and increased filling pressures (E/e'). Histological staining with Masson's trichrome and Picrosirius red showed extensive fibrosis and increased collagen deposition in the ventricular myocardium surrounding blood vessels of treated mice compared to untreated mice. Evans blue permeability assays demonstrated increased cardiac vasculature permeability while primary cardiac endothelial cells exposed to doxorubicin in vitro showed increased cell death as compared to lung or liver endothelial cells. CONCLUSIONS An orthotopic mouse model of human breast cancer in Nude mice treated with doxorubicin and trastuzumab resulted in a cardiac vascular defect accompanied by preserved LV ejection fraction, decreased LV mass, suggesting mild diastolic dysfunction and cardiac remodeling consistent with subclinical cardiotoxicity. Our data suggest that cardiac endothelium is more sensitive to doxorubicin therapy as compared to other organ endothelium and cardiac endothelial damage may correlate with breast cancer treatment-induced cardiotoxicity.
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Affiliation(s)
- Rebecca K Hoffman
- Department of Cancer Biology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Laboratory of Innovative & Translational Nursing Research, School of Nursing at the University of Pennsylvania, Philadelphia, PA, USA
| | - Bang-Jin Kim
- Department of Cancer Biology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Payal D Shah
- Division of Hematology-Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Cardio-Oncology Center of Excellence, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph Carver
- Cardio-Oncology Center of Excellence, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Bonnie Ky
- Cardio-Oncology Center of Excellence, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
| | - Sandra Ryeom
- Department of Cancer Biology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA. .,Cardio-Oncology Center of Excellence, Abramson Cancer Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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21
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Ibrahim ESH, Baruah D, Budde M, Rubenstein J, Frei A, Schlaak R, Gore E, Bergom C. Optimized cardiac functional MRI of small-animal models of cancer radiation therapy. Magn Reson Imaging 2020; 73:130-137. [PMID: 32866598 DOI: 10.1016/j.mri.2020.08.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/23/2020] [Accepted: 08/20/2020] [Indexed: 01/27/2023]
Abstract
Cardiac MRI of small animal models of cancer radiation therapy (RT) is a valuable tool for studying the effect of RT on the heart. However, standard cardiac MRI exams require long scanning times, which is challenging for sick animals that may not survive extended periods of imaging under anesthesia. The purpose of this study is to develop an optimized, fast MRI exam for comprehensive cardiac functional imaging of small-animal models of cancer RT. Ten adult female rats (2 non-irradiated and 8 irradiated) were scanned using the developed exam. Optimal imaging parameters were determined, which minimized scanning time while ensuring measurement accuracy and avoiding imaging artifacts. This optimized, fast MRI exam lasted for 30 min, which was tolerated by all animals. EF was normal in all imaged rats, although it was significantly increased in the irradiated rats, which also showed ventricular hypertrophy. However, myocardial strain was significantly reduced in the irradiated rats. In conclusion, a fast MRI exam has been developed for comprehensive cardiac functional imaging of rats in 30 min, with optimized imaging parameters to ensure accurate measurements and tolerance by irradiated rats. The generated strain measurements provide an early marker of regional cardiac dysfunction before global function is affected.
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Affiliation(s)
- El-Sayed H Ibrahim
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Dhiraj Baruah
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Matthew Budde
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Jason Rubenstein
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Anne Frei
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Rachel Schlaak
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Elizabeth Gore
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA.
| | - Carmen Bergom
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI 53226, USA; Washington University School of Medicine, 4511 Forest Park Ave, St. Louis, MI 63108, USA..
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22
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Feher A, Boutagy NE, Stendahl JC, Hawley C, Guerrera N, Booth CJ, Romito E, Wilson S, Liu C, Sinusas AJ. Computed Tomographic Angiography Assessment of Epicardial Coronary Vasoreactivity for Early Detection of Doxorubicin-Induced Cardiotoxicity. JACC: CARDIOONCOLOGY 2020; 2:207-219. [PMID: 34396230 PMCID: PMC8352292 DOI: 10.1016/j.jaccao.2020.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 11/27/2022]
Abstract
Background The vascular endothelium is a novel target for the detection, management, and prevention of doxorubicin (DOX)-induced cardiotoxicity. Objectives The study aimed to: 1) develop a methodology by computed tomography angiography (CTA) to evaluate stress-induced changes in epicardial coronary diameter; and 2) apply this to a chronic canine model of DOX-induced cardiotoxicity to assess vascular toxicity. Methods To develop and validate quantitative methods, sequential retrospectively gated coronary CTAs were performed in 16 canines. Coronary diameters were measured at prespecified distances during rest, adenosine (ADE) (280 μg/kg/min), rest 30 min post-ADE, and dobutamine (DOB) (5 μg/kg/min). A subgroup of 8 canines received weekly intravenous DOX (1 mg/kg) for 12 to 15 weeks, followed by rest-stress CTA at cumulative doses of ∼4-mg/kg (3 to 5 mg/kg), ∼8-mg/kg (7 to 9 mg/kg), and ∼12-mg/kg (12 to 15 mg/kg) of DOX. Echocardiograms were performed at these timepoints to assess left ventricular ejection fraction and global longitudinal strain. Results Under normal conditions, epicardial coronary arteries reproducibly dilated in response to ADE (left anterior descending coronary artery [LAD]: 12 ± 2%, left circumflex coronary artery [LCx]: 13 ± 2%, right coronary artery [RCA]: 14 ± 2%) and DOB (LAD: 17 ± 3%, LCx: 18 ± 2%, RCA: 15 ± 3%). With DOX, ADE vasodilator responses were impaired after ∼4-mg/kg (LAD: –3 ± 1%, LCx: 0 ± 2%, RCA: –5 ± 2%) and ∼8-mg/kg (LAD: –3 ± 1%, LCx: 0 ± 1%, RCA: –2 ± 2%). The DOB dilation response was preserved at ∼4-mg/kg of DOX (LAD: 18 ± 4%, LCx: 11 ± 3%, RCA: 11 ± 2%) but tended to decrease at ∼8-mg/kg of DOX (LAD: 4 ± 2%, LCx: 8 ± 3%, RCA: 3 ± 2%). A significant left ventricular ejection fraction reduction was observed only at 12 to 15 mg/kg DOX (baseline: 63 ± 2%, 12-mg/kg: 45 ± 3%). Global longitudinal strain was abnormal at ∼4-mg/kg of DOX (p = 0.011). Conclusions CTA can reliably assess epicardial coronary diameter in response to pharmacological stressors, providing a noninvasive functional index of coronary vasoreactivity. Impaired epicardial vasodilation occurs early in DOX-induced cardiotoxicity.
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Key Words
- ADE, adenosine
- CAD, coronary artery disease
- CT angiography
- CTA, computed tomography angiography
- DOB, dobutamine
- DOX, doxorubicin
- GLS, global longitudinal strain
- HR, heart rate
- LAD, left anterior descending coronary artery
- LCx, left circumflex coronary artery
- LV, left ventricular
- LVEF, left ventricular ejection fraction
- MAP, mean arterial pressure
- RCA, right coronary artery
- TTE, transthoracic echocardiography
- anthracycline
- cardiomyopathy
- diagnosis
- imaging
- preclinical study
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Affiliation(s)
- Attila Feher
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Yale Translational Research Imaging Center, Yale University, New Haven, Connecticut, USA
| | - Nabil E. Boutagy
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Yale Translational Research Imaging Center, Yale University, New Haven, Connecticut, USA
| | - John C. Stendahl
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Yale Translational Research Imaging Center, Yale University, New Haven, Connecticut, USA
| | - Christi Hawley
- Yale Translational Research Imaging Center, Yale University, New Haven, Connecticut, USA
| | - Nicole Guerrera
- Yale Translational Research Imaging Center, Yale University, New Haven, Connecticut, USA
| | - Carmen J. Booth
- Department of Comparative Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Eva Romito
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Yale Translational Research Imaging Center, Yale University, New Haven, Connecticut, USA
| | - Steven Wilson
- Department of Comparative Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Chi Liu
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Albert J. Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Yale Translational Research Imaging Center, Yale University, New Haven, Connecticut, USA
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Biomedical Engineering, Yale University School of Medicine, New Haven, Connecticut, USA
- Address for correspondence: Dr. Albert J. Sinusas, Section of Cardiovascular Medicine, Yale University School of Medicine, P.O. Box 208017, Dana 3, New Haven, Connecticut 06520-8017. @attilafehermd
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23
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Harries I, Liang K, Williams M, Berlot B, Biglino G, Lancellotti P, Plana JC, Bucciarelli-Ducci C. Magnetic Resonance Imaging to Detect Cardiovascular Effects of Cancer Therapy: JACC CardioOncology State-of-the-Art Review. JACC CardioOncol 2020; 2:270-292. [PMID: 34396235 PMCID: PMC8352317 DOI: 10.1016/j.jaccao.2020.04.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/12/2020] [Accepted: 04/15/2020] [Indexed: 01/06/2023] Open
Abstract
This paper aims to empower and inform cardio-oncologists by providing a practical guide to the clinical application of cardiac magnetic resonance (CMR) in the rapidly evolving field of cardio-oncology. Specifically, we describe how CMR can be used to assess the cardiovascular effects of cancer therapy. The CMR literature, relevant societal guidelines, indication-specific imaging protocols, and methods to overcome some of the challenges encountered in performing and accessing CMR are reviewed.
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Affiliation(s)
- Iwan Harries
- Bristol Heart Institute, Bristol National Institute of Health Research (NIHR) Biomedical Research Centre, University Hospitals Bristol NHS Trust and University of Bristol. Bristol, United Kingdom
| | - Kate Liang
- Bristol Heart Institute, Bristol National Institute of Health Research (NIHR) Biomedical Research Centre, University Hospitals Bristol NHS Trust and University of Bristol. Bristol, United Kingdom
| | - Matthew Williams
- Bristol Heart Institute, Bristol National Institute of Health Research (NIHR) Biomedical Research Centre, University Hospitals Bristol NHS Trust and University of Bristol. Bristol, United Kingdom
| | - Bostjan Berlot
- Bristol Heart Institute, Bristol National Institute of Health Research (NIHR) Biomedical Research Centre, University Hospitals Bristol NHS Trust and University of Bristol. Bristol, United Kingdom
- Department of Cardiology, University Medical Centre Ljubljana, Slovenia
| | - Giovanni Biglino
- Bristol Heart Institute, Bristol National Institute of Health Research (NIHR) Biomedical Research Centre, University Hospitals Bristol NHS Trust and University of Bristol. Bristol, United Kingdom
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Patrizio Lancellotti
- University of Liège Hospital, GIGA Cardiovascular Sciences, Departments of Cardiology, Heart Valve Clinic, CHU Sart Tilman, Liège, Belgium
- Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - Juan Carlos Plana
- Texas Heart Institute at Baylor St. Luke’s Medical Center, Baylor College of Medicine, Houston, Texas, USA
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol National Institute of Health Research (NIHR) Biomedical Research Centre, University Hospitals Bristol NHS Trust and University of Bristol. Bristol, United Kingdom
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24
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Mavrogeni SI, Sfendouraki E, Markousis-Mavrogenis G, Rigopoulos A, Noutsias M, Kolovou G, Angeli C, Tousoulis D. Cardio-oncology, the myth of Sisyphus, and cardiovascular disease in breast cancer survivors. Heart Fail Rev 2020; 24:977-987. [PMID: 31134427 DOI: 10.1007/s10741-019-09805-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The number of breast cancer (BC) survivors has been increasing lately, due to the improvement in early detection strategies and oncological treatments. However, BC survivors are 3 times as likely to develop heart failure (HF) within 5 years of cancer diagnosis, and 7/100 of them will develop HF in a median follow-up of 8.5 years. Furthermore, HF in BC survivors has a worse prognosis compared to other causes of HF. Anthracyclines and trastuzumab have been proven to improve survival. However, they are also considered as the main causative factors of HF in BC survivors. Old patients, those with a pre-existing cardiovascular (CV) risk factors/disease, prior exposure to chemotherapy and radiotherapy are at increased risk. Serial evaluation of troponins and cardiac imaging parameters using echocardiography and cardiovascular magnetic resonance can significantly contribute to the early diagnosis of cardiac involvement before overt HF will develop. Assessment and immediate treatment of traditional CV risk factors is the first step for cardiotoxicity prevention. In BC survivors with known heart disease, the clinical stabilization is strongly recommended for cardiotoxicity prevention. Finally, in high-risk CV patients, primary prevention including cardioprotectants and/or CV drugs should be applied. According to recent studies, the early start of ACE inhibitors and β-blockers and the modification of anti-cancer treatment can prevent the decline in left ventricular ejection fraction. However, further multicenter studies are needed to establish both prevention and treatment protocols to successfully overcome HF development in BC survivors.
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Affiliation(s)
- Sophie I Mavrogeni
- Onassis Cardiac Surgery Center and Kapodistrian, University of Athens, 50 Esperou Street, 175-61 P. Faliro, Athens, Greece.
| | - Elisa Sfendouraki
- First Cardiology Department, Hippokration Hospital, University of Athens, Athens, Greece
| | - George Markousis-Mavrogenis
- Onassis Cardiac Surgery Center and Kapodistrian, University of Athens, 50 Esperou Street, 175-61 P. Faliro, Athens, Greece
| | - Angelos Rigopoulos
- Mid-German Heart Center, Department of Internal Medicine III (KIM III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Michel Noutsias
- Mid-German Heart Center, Department of Internal Medicine III (KIM III), Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, D-06120, Halle (Saale), Germany
| | - Genovefa Kolovou
- Onassis Cardiac Surgery Center and Kapodistrian, University of Athens, 50 Esperou Street, 175-61 P. Faliro, Athens, Greece
| | - Constantina Angeli
- First Cardiology Department, Hippokration Hospital, University of Athens, Athens, Greece
| | - Dimitrios Tousoulis
- First Cardiology Department, Hippokration Hospital, University of Athens, Athens, Greece
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25
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Cadeddu Dessalvi C, Pepe A, Penna C, Gimelli A, Madonna R, Mele D, Monte I, Novo G, Nugara C, Zito C, Moslehi JJ, de Boer RA, Lyon AR, Tocchetti CG, Mercuro G. Sex differences in anthracycline-induced cardiotoxicity: the benefits of estrogens. Heart Fail Rev 2020; 24:915-925. [PMID: 31256318 DOI: 10.1007/s10741-019-09820-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Anthracyclines are the cornerstone for many oncologic treatments, but their cardiotoxicity has been recognized for several decades. Female subjects, especially before puberty and adolescence, or after menopause, seem to be more at increased risk, with the prognostic impact of this sex issue being less consistent compared to other cardiovascular risk factors. Several studies imply that sex differences could depend on the lack of the protective effect of sex hormones against the anthracycline-initiated damage in cardiac cells, or on differential mitochondria-related oxidative gene expression. This is also reflected by the results obtained with different diagnostic methods, such as cardiovascular biomarkers and imaging techniques (echocardiography, magnetic resonance, and nuclear medicine) in the diagnosis and monitoring of cardiotoxicity, confirming that sex differences exist. The same is true about protective strategies from anthracycline cardiotoxicity. Indeed, first studied to withstand oxidative damage in response to ischemia/reperfusion (I/R) injury, cardioprotection has different outcomes in men and women. A number of studies assessed the differences in I/R response between male and female hearts, with oxidative stress and apoptosis being shared mechanisms between the I/R and anthracyclines heart damage. Sex hormones can modulate these mechanisms, thus confirming their importance in the pathophysiology in cardioprotection not only from the ischemia/reperfusion damage, but also from anthracyclines, fueling further cardio-oncologic research on the topic.
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Affiliation(s)
| | - Alessia Pepe
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio C.N.R.- Regione Toscana, Pisa, Italy
| | - Claudia Penna
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Alessia Gimelli
- Nuclear Medicine Unit, Fondazione G. Monasterio C.N.R.- Regione Toscana, Pisa, Italy
| | - Rosalinda Madonna
- Center of Aging Sciences and Translational Medicine - CESI-MeT, "G. d'Annunzio" University, Chieti, Italy
| | - Donato Mele
- Cardiology Unit, Emergency Department, University Hospital of Ferrara, Ferrara, Italy
| | - Ines Monte
- Department of General Surgery and Medical-Surgery Specialities- Cardiology, University of Catania, Catania, Italy
| | - Giuseppina Novo
- Department of Cardiology, University of Palermo, Palermo, Italy
| | - Cinzia Nugara
- Department of Cardiology, University of Palermo, Palermo, Italy
| | - Concetta Zito
- Department of Clinical and Experimental Medicine - Cardiology, University of Messina, Messina, Italy
| | - Javid J Moslehi
- Vanderbilt Ingram Cancer Center, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Rudolf A de Boer
- University Medical Center Groningen, Department of Cardiology, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, the Netherlands
| | | | - Carlo Gabriele Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples, Italy. .,Interdepartmental Center for Clinical and Translational Research (CIRCET), Federico II University, Naples, Italy.
| | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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26
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Rahimi O, Kirby J, Varagic J, Westwood B, Tallant EA, Gallagher PE. Angiotensin-(1–7) reduces doxorubicin-induced cardiac dysfunction in male and female Sprague-Dawley rats through antioxidant mechanisms. Am J Physiol Heart Circ Physiol 2020; 318:H883-H894. [DOI: 10.1152/ajpheart.00224.2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Doxorubicin (Dox) is an effective chemotherapeutic for a variety of pediatric malignancies. Unfortunately, Dox administration often results in a cumulative dose-dependent cardiotoxicity that manifests with marked oxidative stress, leading to heart failure. Adjunct therapies are needed to mitigate Dox cardiotoxicity and enhance quality of life in pediatric patients with cancer. Angiotensin-(1–7) [Ang-(1–7)] is an endogenous hormone with cardioprotective properties. This study investigated whether adjunct Ang-(1–7) attenuates cardiotoxicity resulting from exposure to Dox in male and female juvenile rats. Dox significantly reduced body mass, and the addition of Ang-(1–7) had no effect. However, adjunct Ang-(1–7) prevented Dox-mediated diastolic dysfunction, including markers of decreased passive filling as measured by reduced early diastole mitral valve flow velocity peak ( E) ( P < 0.05) and early diastole mitral valve annulus peak velocity ( e′; P < 0.001) and increased E/e′ ( P < 0.001), an echocardiographic measure of diastolic dysfunction. Since Dox treatment increases reactive oxygen species (ROS), the effect of Ang-(1–7) on oxidative by-products and enzymes that generate or reduce ROS was investigated. In hearts of male and female juvenile rats, Dox increased NADPH oxidase 4 ( P < 0.05), a major cardiovascular NADPH oxidase isozyme that generates ROS, as well as 4-hydroxynonenal ( P < 0.001) and malondialdehyde ( P < 0.001), markers of lipid peroxidation; Ang-(1–7) prevented these effects of Dox. Cotreatment with Dox and Ang-(1–7) increased the antioxidant enzymes SOD1 (male: P < 0.05; female: P < 0.01) and catalase ( P < 0.05), which likely contributed to reduced ROS. These results demonstrate that Ang-(1–7) prevents diastolic dysfunction in association with a reduction in ROS, suggesting that the heptapeptide hormone may serve as an effective adjuvant to improve Dox-induced cardiotoxicity. NEW & NOTEWORTHY Ang-(1–7) is a clinically safe peptide hormone with cardioprotective and antineoplastic properties that could be used as an adjuvant therapy to improve cancer treatment and mitigate the long-term cardiotoxicity associated with doxorubicin in pediatric patients with cancer.
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Affiliation(s)
- Omeed Rahimi
- Hypertension and Vascular Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jay Kirby
- Hypertension and Vascular Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Jasmina Varagic
- Hypertension and Vascular Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Brian Westwood
- Hypertension and Vascular Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - E. Ann Tallant
- Hypertension and Vascular Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Patricia E. Gallagher
- Hypertension and Vascular Research, Wake Forest School of Medicine, Winston-Salem, North Carolina
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27
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Demissei BG, Hubbard RA, Zhang L, Smith AM, Sheline K, McDonald C, Narayan V, Domchek SM, DeMichele A, Shah P, Clark AS, Fox K, Matro J, Bradbury AR, Knollman H, Getz KD, Armenian SH, Januzzi JL, Tang WHW, Liu P, Ky B. Changes in Cardiovascular Biomarkers With Breast Cancer Therapy and Associations With Cardiac Dysfunction. J Am Heart Assoc 2020; 9:e014708. [PMID: 31959034 PMCID: PMC7033834 DOI: 10.1161/jaha.119.014708] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background We examined the longitudinal associations between changes in cardiovascular biomarkers and cancer therapy–related cardiac dysfunction (CTRCD) in patients with breast cancer treated with cardotoxic cancer therapy. Methods and Results Repeated measures of high‐sensitivity cardiac troponin T (hs‐cTnT), NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide), myeloperoxidase, placental growth factor, and growth differentiation factor 15 were assessed longitudinally in a prospective cohort of 323 patients treated with anthracyclines and/or trastuzumab followed over a maximum of 3.7 years with serial echocardiograms. CTRCD was defined as a ≥10% decline in left ventricular ejection fraction to a value <50%. Associations between changes in biomarkers and left ventricular ejection fraction were evaluated in repeated‐measures linear regression models. Cox regression models assessed the associations between biomarkers and CTRCD. Early increases in all biomarkers occurred with anthracycline‐based regimens. hs‐cTnT levels >14 ng/L at anthracycline completion were associated with a 2‐fold increased CTRCD risk (hazard ratio, 2.01; 95% CI, 1.00–4.06). There was a modest association between changes in NT‐proBNP and left ventricular ejection fraction in the overall cohort; this was most pronounced with sequential anthracycline and trastuzumab (1.1% left ventricular ejection fraction decline [95% CI, −1.8 to –0.4] with each NT‐proBNP doubling). Increases in NT‐proBNP were also associated with CTRCD (hazard ratio per doubling, 1.56; 95% CI, 1.32–1.84). Increases in myeloperoxidase were associated with CTRCD in patients who received sequential anthracycline and trastuzumab (hazard ratio per doubling, 1.28; 95% CI, 1.04–1.58). Conclusions Cardiovascular biomarkers may play an important role in CTRCD risk prediction in patients with breast cancer who receive cardiotoxic cancer therapy, particularly in those treated with sequential anthracycline and trastuzumab therapy. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01173341.
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Affiliation(s)
- Biniyam G Demissei
- Department of Medicine Division of Cardiology Perelman School of Medicine at the University of Pennsylvania Philadelphia PA
| | - Rebecca A Hubbard
- Department of Biostatistics, Epidemiology & Informatics Perelman School of Medicine at the University of Pennsylvania Philadelphia PA
| | - Liyong Zhang
- Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Amanda M Smith
- Department of Medicine Division of Cardiology Perelman School of Medicine at the University of Pennsylvania Philadelphia PA
| | - Karyn Sheline
- Department of Medicine Division of Cardiology Perelman School of Medicine at the University of Pennsylvania Philadelphia PA
| | - Caitlin McDonald
- Department of Medicine Division of Cardiology Perelman School of Medicine at the University of Pennsylvania Philadelphia PA
| | - Vivek Narayan
- Abramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PA.,Department of Medicine Division of Hematology and Oncology University of Pennsylvania Philadelphia PA
| | - Susan M Domchek
- Abramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PA.,Department of Medicine Division of Hematology and Oncology University of Pennsylvania Philadelphia PA
| | - Angela DeMichele
- Abramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PA.,Department of Medicine Division of Hematology and Oncology University of Pennsylvania Philadelphia PA
| | - Payal Shah
- Abramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PA.,Department of Medicine Division of Hematology and Oncology University of Pennsylvania Philadelphia PA
| | - Amy S Clark
- Abramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PA.,Department of Medicine Division of Hematology and Oncology University of Pennsylvania Philadelphia PA
| | - Kevin Fox
- Abramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PA.,Department of Medicine Division of Hematology and Oncology University of Pennsylvania Philadelphia PA
| | - Jennifer Matro
- Abramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PA.,Department of Medicine Division of Hematology and Oncology University of Pennsylvania Philadelphia PA
| | - Angela R Bradbury
- Abramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PA.,Department of Medicine Division of Hematology and Oncology University of Pennsylvania Philadelphia PA
| | - Hayley Knollman
- Abramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PA.,Department of Medicine Division of Hematology and Oncology University of Pennsylvania Philadelphia PA
| | - Kelly D Getz
- Division of Oncology The Children's Hospital of Philadelphia PA
| | | | - James L Januzzi
- Division of Cardiovascular Medicine Massachusetts General Hospital Boston MA
| | - W H Wilson Tang
- Division of Cardiovascular Medicine Cleveland Clinic Cleveland OH
| | - Peter Liu
- Division of Cardiology University of Ottawa Heart Institute Ottawa Ontario Canada
| | - Bonnie Ky
- Department of Medicine Division of Cardiology Perelman School of Medicine at the University of Pennsylvania Philadelphia PA.,Department of Biostatistics, Epidemiology & Informatics Perelman School of Medicine at the University of Pennsylvania Philadelphia PA.,Abramson Cancer Center Perelman School of Medicine at the University of Pennsylvania Philadelphia PA
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28
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Abstract
Cardiovascular magnetic resonance (CMR) imaging is useful to identify systolic dysfunction, particularly when echocardiographic imaging is not acceptable because of poor acoustic windows or when left ventricular ejection fraction (LVEF) is inconclusive by other modalities and an accurate LVEF measurement is needed. Of particular advantage in cardio-oncology is CMR's capability to perform tissue characterization to noninvasively identify changes in pathologic conditions related to cancer therapy or to discriminate causes of disease that may confound presentation in cardio-oncology patients. For these reasons, there is an increasing use of CMR in the screening and surveillance of cardio-oncology patients.
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Affiliation(s)
- Jennifer Hawthorne Jordan
- Department of Biomedical Engineering, Virginia Commonwealth University, Pauley Heart Center, Virginia Commonwealth University Health Sciences, 8-119B, 1200 East Broad Street, Richmond, VA 23298, USA.
| | - William Gregory Hundley
- Pauley Heart Center, Virginia Commonwealth University Health Sciences, 8-124, 1200 East Broad Street, Richmond, VA 23298, USA
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29
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Upadhya B, Rocco MV, Pajewski NM, Morgan T, Blackshear J, Hundley WG, Oparil S, Soliman EZ, Cohen DL, Hamilton CA, Cho ME, Kostis WJ, Papademetriou V, Rodriguez CJ, Raj DS, Townsend R, Vasu S, Zamanian S, Kitzman DW. Effect of Intensive Blood Pressure Reduction on Left Ventricular Mass, Structure, Function, and Fibrosis in the SPRINT-HEART. Hypertension 2019; 74:276-284. [PMID: 31256724 PMCID: PMC7098010 DOI: 10.1161/hypertensionaha.119.13073] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
In observational studies, left ventricular mass (LVM) and structure are strong predictors of mortality and cardiovascular events. However, the effect of hypertension treatment on LVM reduction and its relation to subsequent outcomes is unclear, particularly at lower blood pressure (BP) targets. In an ancillary study of SPRINT (Systolic Blood Pressure Intervention Trial), where participants were randomly assigned to intensive BP control (target systolic BP target <120 mm Hg) versus standard BP control (<140 mm Hg), cardiac magnetic resonance imaging was performed at baseline and 18-month follow-up to measure: LVM, volumes, ejection fraction, and native T1 mapping for myocardial fibrosis. At baseline, 337 participants were examined (age: 64±9 years, 45% women); 300 completed the 18-month exam (153 intensive control and 147 standard control). In the intensive versus standard BP control group at 18 months, there was no difference in change in LVM (mean±SE =-2.7±0.5 g versus -2.3±0.7 g; P=0.368), ejection fraction, or native T1 (P=0.79), but there was a larger decrease in LVM/end-diastolic volume ratio (-0.04±0.01 versus -0.01±0.01; P=0.002) a measure of concentric LV remodeling. There were fewer cardiovascular events in the intensive control group, but no significant association between the reduced events and change in LVM or any other cardiac magnetic resonance imaging measure. In SPRINT-HEART, contrary to our hypothesis, there were no significant between-group differences in LVM, function, or myocardial T1 at 18-month follow-up. These results suggests that mediators other than these LV measures contribute to the improved cardiovascular outcomes with intensive BP control.
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Affiliation(s)
- Bharathi Upadhya
- From the Cardiovascular Medicine Section (B.U., W.G.H., C.J.R., S.V., D.W.K.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Michael V Rocco
- Nephrology Section (M.V.R.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Nicholas M Pajewski
- Department of Internal Medicine, Department of Biostatistics and Data Science (N.M.P., T.M.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Tim Morgan
- Department of Internal Medicine, Department of Biostatistics and Data Science (N.M.P., T.M.), Wake Forest School of Medicine, Winston-Salem, NC
| | | | - William Greg Hundley
- From the Cardiovascular Medicine Section (B.U., W.G.H., C.J.R., S.V., D.W.K.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Suzanne Oparil
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama, Birmingham (S.O.)
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center, Division of Public Health Sciences (E.Z.S.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Debbie L Cohen
- Medicine-Nephrology, University of Pennsylvania, Philadelphia (D.L.C., R.T.)
| | - Craig A Hamilton
- Biomedical Engineering (C.A.H.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Monique E Cho
- Division of Hypertension and Nephrology, University of Utah, Salt Lake City (M.E.C.)
| | | | | | - Carlos J Rodriguez
- From the Cardiovascular Medicine Section (B.U., W.G.H., C.J.R., S.V., D.W.K.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Dominic S Raj
- Medicine-Nephrology, George Washington University School of Medicine, District of Columbia (D.S.R.)
| | - Ray Townsend
- Medicine-Nephrology, University of Pennsylvania, Philadelphia (D.L.C., R.T.)
| | - Sujethra Vasu
- From the Cardiovascular Medicine Section (B.U., W.G.H., C.J.R., S.V., D.W.K.), Wake Forest School of Medicine, Winston-Salem, NC
| | - Sara Zamanian
- Department of Medicine, Case Western Reserve University, Cleveland, OH (S.Z.)
| | - Dalane W Kitzman
- From the Cardiovascular Medicine Section (B.U., W.G.H., C.J.R., S.V., D.W.K.), Wake Forest School of Medicine, Winston-Salem, NC
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30
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Jordan JH, Castellino SM, Meléndez GC, Klepin HD, Ellis LR, Lamar Z, Vasu S, Kitzman DW, Ntim WO, Brubaker PH, Reichek N, D'Agostino RB, Hundley WG. Left Ventricular Mass Change After Anthracycline Chemotherapy. Circ Heart Fail 2019; 11:e004560. [PMID: 29991488 DOI: 10.1161/circheartfailure.117.004560] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 05/04/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Myocardial atrophy and left ventricular (LV) mass reductions are associated with fatigue and exercise intolerance. The relationships between the receipt of anthracycline-based chemotherapy (Anth-bC) and changes in LV mass and heart failure (HF) symptomatology are unknown, as is their relationship to LV ejection fraction (LVEF), a widely used measurement performed in surveillance strategies designed to avert symptomatic HF associated with cancer treatment. METHODS AND RESULTS We performed blinded, serial assessments of body weight, LVEF and mass, LV-arterial coupling, aortic stiffness, and Minnesota Living with Heart Failure Questionnaire measures before and 6 months after initiating Anth-bC (n=61) and non-Anth-bC (n=15), and in 24 cancer-free controls using paired t and χ2 tests and multivariable linear models. Participants averaged 51±12 years, and 70% were women. Cancer diagnoses included breast cancer (53%), hematologic malignancy (42%), and soft tissue sarcoma (5%). We observed a 5% decline in both LVEF (P<0.0001) and LV mass (P=0.03) in the setting of increased aortic stiffness and disrupted ventricular-arterial coupling in those receiving Anth-bC but not other groups (P=0.11-0.92). A worsening of the Minnesota Living with Heart Failure Questionnaire score in Anth-bC recipients was associated with myocardial mass declines (r=-0.27; P<0.01) but not with LVEF declines (r=0.11; P=0.45). Moreover, this finding was independent of LVEF changes and body weight. CONCLUSIONS Early after Anth-bC, LV mass reductions associate with worsening HF symptomatology independent of LVEF. These data suggest an alternative mechanism whereby anthracyclines may contribute to HF symptomatology and raise the possibility that surveillance strategies during Anth-bC should also assess LV mass.
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Affiliation(s)
- Jennifer H Jordan
- Sections on Cardiovascular Medicine (J.H.J., G.C.M., S.V., D.W.K., W.O.N., W.G.H.)
| | | | - Giselle C Meléndez
- Sections on Cardiovascular Medicine (J.H.J., G.C.M., S.V., D.W.K., W.O.N., W.G.H.).,Department of Internal Medicine, Section on Comparative Medicine, Department of Pathology (G.C.M.)
| | | | | | | | - Sujethra Vasu
- Sections on Cardiovascular Medicine (J.H.J., G.C.M., S.V., D.W.K., W.O.N., W.G.H.)
| | - Dalane W Kitzman
- Sections on Cardiovascular Medicine (J.H.J., G.C.M., S.V., D.W.K., W.O.N., W.G.H.)
| | - William O Ntim
- Sections on Cardiovascular Medicine (J.H.J., G.C.M., S.V., D.W.K., W.O.N., W.G.H.)
| | - Peter H Brubaker
- Wake Forest School of Medicine, and Department of Health and Exercise Sciences (P.H.B)
| | - Nathaniel Reichek
- Wake Forest University, Winston-Salem, NC. Research and Education, The Heart Center, St Francis Hospital, Roslyn, NY (N.R.)
| | - Ralph B D'Agostino
- Department of Biostatistical Sciences, Division of Public Health Sciences (R.B.D'A.)
| | - W Gregory Hundley
- Sections on Cardiovascular Medicine (J.H.J., G.C.M., S.V., D.W.K., W.O.N., W.G.H.) .,Department of Radiological Sciences (W.G.H.)
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31
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Heck SL, Gulati G, Hoffmann P, von Knobelsdorff-Brenkenhoff F, Storås TH, Ree AH, Gravdehaug B, Røsjø H, Steine K, Geisler J, Schulz-Menger J, Omland T. Effect of candesartan and metoprolol on myocardial tissue composition during anthracycline treatment: the PRADA trial. Eur Heart J Cardiovasc Imaging 2019; 19:544-552. [PMID: 29106497 DOI: 10.1093/ehjci/jex159] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 05/24/2017] [Indexed: 02/04/2023] Open
Abstract
Aims Anthracycline treatment may cause myocyte loss and expansion of the myocardial extracellular volume (ECV) fraction by oedema and fibrosis. We tested the hypotheses that adjuvant treatment for early breast cancer with the anthracycline epirubicin is dose dependently associated with increased ECV fraction and total ECV, as well as reduced total myocardial cellular volume, and that these changes could be prevented by concomitant angiotensin or beta-adrenergic blockade. Methods and results PRevention of cArdiac Dysfunction during Adjuvant breast cancer therapy (PRADA) was a 2 × 2 factorial, placebo-controlled, double-blinded trial of candesartan and metoprolol. Sixty-nine women had valid ECV measurements. ECV fraction, total ECV, and total cellular volume were measured by cardiovascular magnetic resonance before and at the completion of anthracycline therapy. ECV fraction increased from 27.5 ± 2.7% to 28.6 ± 2.9% (P = 0.002). A cumulative doxorubicin equivalent dose of 268 mg/m2 was associated with greater increase in ECV fraction than doses <268 mg/m2 (mean change 3.4% [95% confidence interval (CI) 1.2, 5.5] vs. 0.7% [95% CI 0.0, 1.5], P = 0.006), as well as greater increase in total ECV (1.9 mL [95% CI 0.4, 3.5] vs. 0.1 mL [95% CI -0.6, 0.8], P = 0.04). In patients receiving candesartan, total cellular volume decreased (-3.5 mL [95% CI - 4.7, -2.2], P < 0.001) while in patients not receiving candesartan, it remained unchanged (P = 0.45; between group difference P = 0.003). Conclusions Anthracycline therapy is associated with dose-dependent increase in ECV fraction and total ECV. Concomitant treatment with candesartan reduces left ventricular total cellular volume.
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Affiliation(s)
- Siri Lagethon Heck
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway.,Center for Heart Failure Research, University of Oslo, Campus AHUS, Sykehusveien 25, 1474 Nordbyhagen, Norway.,Department of Radiology, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway
| | - Geeta Gulati
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway.,Center for Heart Failure Research, University of Oslo, Campus AHUS, Sykehusveien 25, 1474 Nordbyhagen, Norway
| | - Pavel Hoffmann
- Section for Interventional Cardiology, Department of Cardiology, Oslo University Hospital, Ullevål, Kirkeveien 166, 0450 Oslo, Norway
| | - Florian von Knobelsdorff-Brenkenhoff
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine; and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Lindenberger Weg 80, 13125 Berlin, Germany.,Clinic Agatharied, Dept. of Cardiology, Ludwig-Maximilians-University of Munich, Norbert-Kerkel-Platz, 83734 Hausham, Germany
| | - Tryggve Holck Storås
- Department for Diagnostic Physics, KRN, Oslo University Hospital, Postboks 4950 Nydalen, 0424 OSLO, Norway
| | - Anne Hansen Ree
- Department of Oncology, Division of Medicine, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Campus AHUS, Sykehusveien 25, 1474 Nordbyhagen, Norway
| | - Berit Gravdehaug
- Department of Breast and Endocrine Surgery, Division of Surgery, Akershus University Hospital, Campus AHUS, Sykehusveien 25, 1478 Nordbyhagen, Norway; Lørenskog, Norway
| | - Helge Røsjø
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway.,Center for Heart Failure Research, University of Oslo, Campus AHUS, Sykehusveien 25, 1474 Nordbyhagen, Norway
| | - Kjetil Steine
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway.,Center for Heart Failure Research, University of Oslo, Campus AHUS, Sykehusveien 25, 1474 Nordbyhagen, Norway
| | - Jürgen Geisler
- Department of Oncology, Division of Medicine, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway.,Institute of Clinical Medicine, University of Oslo, Campus AHUS, Sykehusveien 25, 1474 Nordbyhagen, Norway
| | - Jeanette Schulz-Menger
- Working Group Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrueck Center for Molecular Medicine; and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Lindenberger Weg 80, 13125 Berlin, Germany
| | - Torbjørn Omland
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Sykehusveien 25, 1478 Lørenskog, Norway.,Center for Heart Failure Research, University of Oslo, Campus AHUS, Sykehusveien 25, 1474 Nordbyhagen, Norway
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32
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Galán-Arriola C, Lobo M, Vílchez-Tschischke JP, López GJ, de Molina-Iracheta A, Pérez-Martínez C, Agüero J, Fernández-Jiménez R, Martín-García A, Oliver E, Villena-Gutierrez R, Pizarro G, Sánchez PL, Fuster V, Sánchez-González J, Ibanez B. Serial Magnetic Resonance Imaging to Identify Early Stages of Anthracycline-Induced Cardiotoxicity. J Am Coll Cardiol 2019; 73:779-791. [DOI: 10.1016/j.jacc.2018.11.046] [Citation(s) in RCA: 96] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 10/14/2018] [Accepted: 11/08/2018] [Indexed: 12/31/2022]
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33
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Dreyfuss AD, Bravo PE, Koumenis C, Ky B. Precision Cardio-Oncology. J Nucl Med 2019; 60:443-450. [PMID: 30655328 DOI: 10.2967/jnumed.118.220137] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 12/29/2018] [Indexed: 01/07/2023] Open
Abstract
Modern oncologic therapies and care have resulted in a growing population of cancer survivors with comorbid, chronic health conditions. As an example, many survivors have an increased risk of cardiovascular complications secondary to cardiotoxic systemic and radiation therapies. In response, the field of cardio-oncology has emerged as an integral component of oncologic patient care, committed to the early diagnosis and treatment of adverse cardiac events. However, as current clinical management of cancer therapy-related cardiovascular disease remains limited by a lack of phenotypic data, implementation of precision medicine approaches has become a focal point for deep phenotyping strategies. In particular, -omics approaches (a field of study in biology ending in -omic, such as genomics, proteomics, or metabolomics) have shown enormous potential in identifying sensitive biomarkers of cardiovascular disease, applying sophisticated, pattern-revealing technologies to growing databases of biologic molecules. Moreover, the use of -omics to inform radiologic strategies may add a dimension to future clinical practices. In this review, we present a paradigm for a precision medicine approach to the care of cardiotoxin-exposed cancer patients. We discuss the role of current imaging techniques; demonstrate how -omics can advance our understanding of disease phenotypes; and describe how molecular imaging can be integrated to personalize surveillance and therapeutics, ultimately reducing cardiovascular morbidity and mortality in cancer patients and survivors.
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Affiliation(s)
- Alexandra D Dreyfuss
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Paco E Bravo
- Division of Nuclear Medicine, Department of Radiology, University of Pennsylvania, Philadelphia, Pennsylvania.,Division of Cardiology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and
| | - Constantinos Koumenis
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Bonnie Ky
- Division of Cardiology, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and .,Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
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34
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CMR imaging biosignature of cardiac involvement due to cancer-related treatment by T1 and T2 mapping. Int J Cardiol 2019; 275:179-186. [DOI: 10.1016/j.ijcard.2018.10.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Revised: 09/20/2018] [Accepted: 10/05/2018] [Indexed: 11/21/2022]
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35
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National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Guidelines for the Prevention, Detection, and Management of Heart Failure in Australia 2018. Heart Lung Circ 2018; 27:1123-1208. [DOI: 10.1016/j.hlc.2018.06.1042] [Citation(s) in RCA: 203] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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36
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Abstract
Recent advances in cancer prevention and management have led to an exponential increase of cancer survivors worldwide. Regrettably, cardiovascular disease has risen in the aftermath as one of the most devastating consequences of cancer therapies. In this work, we define cancer therapeutics-induced cardiotoxicity as the direct or indirect cardiovascular injury or injurious effect caused by cancer therapies. We describe four progressive stages of this condition and four corresponding levels of prevention, each having a specific goal, focus, and means of action. We subsequently unfold this didactic framework, surveying mechanisms of cardiotoxicity, risk factors, cardioprotectants, biomarkers, and diagnostic imaging modalities. Finally, we outline the most current evidence-based recommendations in this area according to multidisciplinary expert consensus guidelines.
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Affiliation(s)
- J Emanuel Finet
- Section of Heart Failure and Transplantation Medicine, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, and Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, USA
| | - W H Wilson Tang
- Section of Heart Failure and Transplantation Medicine, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, and Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, USA.,Cleveland Clinic Lerner College of Medicine at Case Western Reserve University; Center for Clinical Genomics; Cleveland Clinic, Cleveland, USA
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37
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Jordan JH, Todd RM, Vasu S, Hundley WG. Cardiovascular Magnetic Resonance in the Oncology Patient. JACC Cardiovasc Imaging 2018; 11:1150-1172. [PMID: 30092971 PMCID: PMC6242266 DOI: 10.1016/j.jcmg.2018.06.004] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 06/05/2018] [Accepted: 06/14/2018] [Indexed: 01/20/2023]
Abstract
Patients with or receiving potentially cardiotoxic treatment for cancer are susceptible to developing decrements in left ventricular mass, diastolic function, or systolic function. They may also experience valvular heart disease, pericardial disease, or intracardiac masses. Cardiovascular magnetic resonance may be used to assess cardiac anatomy, structure, and function and to characterize myocardial tissue. This combination of features facilitates the diagnosis and management of disease processes in patients with or those who have survived cancer. This report outlines and describes prior research involving cardiovascular magnetic resonance for assessing cardiovascular disease in patients with or previously having received treatment for cancer.
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Affiliation(s)
- Jennifer H Jordan
- Department of Internal Medicine, Section on Cardiovascular Medicine at the Wake Forest School of Medicine, Winston-Salem, North Carolina.
| | - Ryan M Todd
- Department of Internal Medicine, Section on Cardiovascular Medicine at the Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Sujethra Vasu
- Department of Internal Medicine, Section on Cardiovascular Medicine at the Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - W Gregory Hundley
- Department of Internal Medicine, Section on Cardiovascular Medicine at the Wake Forest School of Medicine, Winston-Salem, North Carolina
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38
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Multi-Modality Imaging in the Assessment of Cardiovascular Toxicity in the Cancer Patient. JACC Cardiovasc Imaging 2018; 11:1173-1186. [DOI: 10.1016/j.jcmg.2018.06.003] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 06/06/2018] [Accepted: 06/18/2018] [Indexed: 12/17/2022]
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39
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Boutagy NE, Wu J, Cai Z, Zhang W, Booth CJ, Kyriakides TC, Pfau D, Mulnix T, Liu Z, Miller EJ, Young LH, Carson RE, Huang Y, Liu C, Sinusas AJ. In Vivo Reactive Oxygen Species Detection With a Novel Positron Emission Tomography Tracer, 18F-DHMT, Allows for Early Detection of Anthracycline-Induced Cardiotoxicity in Rodents. JACC Basic Transl Sci 2018; 3:378-390. [PMID: 30062224 PMCID: PMC6058999 DOI: 10.1016/j.jacbts.2018.02.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 02/06/2018] [Accepted: 02/09/2018] [Indexed: 02/05/2023]
Abstract
LVEF is used to detect doxorubicin-induced cardiotoxicity in patients, but this index is variable and has limited ability to detect early cardiotoxicity. Doxorubicin induces cardiotoxicity largely through the excessive production of ROS. We hypothesized that 18F-DHMT, a PET tracer that detects superoxide production, would provide an early index of cardiotoxicity in rodents. 18F-DHMT PET imaging was able to detect an elevation in cardiac superoxide production before a fall in LVEF. The early elevation in myocardial superoxide production was associated with only mild myocardial toxicity and occurred before cellular apoptosis or significant activation of MMPs; enzymes associated with myocardial remodeling. A drop in LVEF was associated with a significant increase in MMP activation, cellular apoptosis, and significant myocardial toxicity.
Reactive oxygen species (ROS) are involved in doxorubicin-induced cardiotoxicity. The authors investigated the efficacy of 18F-DHMT, a marker of ROS, for early detection of doxorubicin-induced cardiotoxicity in rats. Echocardiography was performed at baseline and 4, 6, and 8 weeks post-doxorubicin initiation, whereas in vivo superoxide production was measured at 4 and 6 weeks with 18F-DHMT positron emission tomography. Left ventricular ejection fraction (LVEF) was not significantly decreased until 6 weeks post-doxorubicin treatment, whereas myocardial superoxide production was significantly elevated at 4 weeks. 18F-DHMT imaging detected an elevation in cardiac superoxide production before a fall in LVEF in rodents and may allow for early cardiotoxicity detection in cancer patients.
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Key Words
- 2D, 2-dimensional
- CT, computed tomography
- DOX, doxorubicin HCl
- H&E, hematoxylin and eosin
- LV, left ventricle/ventricular
- LVEF, left ventricular ejection fraction
- MMP, matrix metalloproteinase
- MT, Masson’s trichrome
- PET, positron emission tomography
- ROS, reactive oxygen species
- SUV, standardized uptake value
- TUNEL, terminal deoxynucleotidyl transferase-mediated nick-end labeling
- VOI, volume of interest
- cardiotoxicity
- doxorubicin
- positron emission tomography
- reactive oxygen species
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Affiliation(s)
- Nabil E. Boutagy
- Section of Cardiovascular Medicine, Department of Medicine, Yale Translational Research Imaging Center, Yale School of Medicine, New Haven, Connecticut
| | - Jing Wu
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Zhengxi Cai
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Wenjie Zhang
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China
| | - Carmen J. Booth
- Section of Comparative Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Tassos C. Kyriakides
- Yale School of Public Health (Biostatistics), Yale School of Medicine, New Haven, Connecticut
| | - Daniel Pfau
- Section of Cardiovascular Medicine, Department of Medicine, Yale Translational Research Imaging Center, Yale School of Medicine, New Haven, Connecticut
| | - Tim Mulnix
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Zhao Liu
- Section of Cardiovascular Medicine, Department of Medicine, Yale Translational Research Imaging Center, Yale School of Medicine, New Haven, Connecticut
| | - Edward J. Miller
- Section of Cardiovascular Medicine, Department of Medicine, Yale Translational Research Imaging Center, Yale School of Medicine, New Haven, Connecticut
| | - Lawrence H. Young
- Section of Cardiovascular Medicine, Department of Medicine, Yale Translational Research Imaging Center, Yale School of Medicine, New Haven, Connecticut
| | - Richard E. Carson
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Yiyun Huang
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Chi Liu
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
| | - Albert J. Sinusas
- Section of Cardiovascular Medicine, Department of Medicine, Yale Translational Research Imaging Center, Yale School of Medicine, New Haven, Connecticut
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
- Address for correspondence: Dr. Albert J. Sinusas, Section of Cardiovascular Medicine, Yale University School of Medicine, P.O. Box 208017, Dana 3, New Haven, Connecticut 06520-8017.
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Gregory Hundley W. The Role of Cardiovascular Magnetic Resonance in the Management of Patients with Cancer. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:30. [PMID: 29556816 DOI: 10.1007/s11936-018-0626-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW This article reviews the utility of cardiovascular magnetic resonance imaging (CMR) to detect abnormalities of the cardiovascular system that may result from cancer or its treatment. RECENT FINDINGS With CMR, one may assess cardiac anatomy, function, myocardial perfusion, tissue composition, and blood flow. For those with cancer, these capabilities allow one to differentiate myocardial masses that may relate to the presence of cancer and evaluate diseases of the pericardium. These features facilitate measurement of left ventricular (LV) volumes, ejection fraction, mass, strain, T1 and T2 relaxation properties, and the extracellular volume fraction all of which may be useful for detecting subclinical cardiovascular injury that results from the receipt of potentially cardiotoxic cancer treatment. CMR can provide an effective and efficient means to identify clinical abnormalities resulting from the diagnosis of cancer or subclinical cardiac injury that may be related to receipt of the therapy for cancer.
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Affiliation(s)
- W Gregory Hundley
- Department of Internal Medicine (Section on Cardiovascular Medicine), Wake Forest Health Sciences, Winston-Salem, NC, 27103, USA. .,Department of Radiology, Wake Forest Health Sciences, Winston-Salem, NC, 27103, USA. .,Wake Forest Health Sciences, Bowman Gray Campus, Medical Center Boulevard, Winston-Salem, NC, 27157-1045, USA.
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41
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Kim H, Chung WB, Cho KI, Kim BJ, Seo JS, Park SM, Kim HJ, Lee JH, Kim EK, Youn HJ. Diagnosis, Treatment, and Prevention of Cardiovascular Toxicity Related to Anti-Cancer Treatment in Clinical Practice: An Opinion Paper from the Working Group on Cardio-Oncology of the Korean Society of Echocardiography. J Cardiovasc Ultrasound 2018; 26:1-25. [PMID: 29629020 PMCID: PMC5881080 DOI: 10.4250/jcu.2018.26.1.1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/26/2018] [Accepted: 02/26/2018] [Indexed: 12/17/2022] Open
Abstract
Cardiovascular (CV) toxicity associated with anti-cancer treatment is commonly encountered and raises critical problems that often result in serious morbidity or mortality. Most cardiac toxicities are related to the cumulative dose of chemotherapy; however, the type of chemotherapy, concomitant agents, and/or conventional CV risk factors have been frequently implicated in CV toxicity. Approximately half of the patients exhibiting CV toxicity receive an anthracycline-based regimen. Therefore, serologic biomarkers or cardiac imagings are important during anti-cancer treatment for early detection and the decision of appropriate management of cardiotoxicity. However, given the difficulty in determining a causal relationship, a multidisciplinary collaborative approach between cardiologists and oncologists is required. In this review, we summarize the CV toxicity and focus on the role of cardiac imaging in management strategies for cardiotoxicity associated with anti-cancer treatment.
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Affiliation(s)
- Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Woo-Baek Chung
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyoung Im Cho
- Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Bong-Joon Kim
- Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Jeong-Sook Seo
- Division of Cardiology, Department of Internal Medicine, Busan Paik Hospital, Inje University, Busan, Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hak Jin Kim
- Department of Cardiology, Center for Clinical Specialty, National Cancer Center, Goyang, Korea
| | - Ju-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Medicine, Cardiovascular and Stroke Imaging Center, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ho-Joong Youn
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Spallarossa P, Maurea N, Cadeddu C, Madonna R, Mele D, Monte I, Novo G, Pagliaro P, Pepe A, Tocchetti CG, Zito C, Mercuro G. A recommended practical approach to the management of anthracycline-based chemotherapy cardiotoxicity: an opinion paper of the working group on drug cardiotoxicity and cardioprotection, Italian Society of Cardiology. J Cardiovasc Med (Hagerstown) 2018; 17 Suppl 1 Special issue on Cardiotoxicity from Antiblastic Drugs and Cardioprotection:e84-e92. [PMID: 27183529 PMCID: PMC4927325 DOI: 10.2459/jcm.0000000000000381] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Anthracyclines are the mainstay of treatment of a variety of haematological malignancies and solid tumours. Unfortunately, the clinical use of these drugs is limited by cumulative, dose-related cardiotoxicity which may ultimately lead to a severe and irreversible form of cardiomyopathy. Thus, there is an increasing need for close cooperation among cardiologists, oncologists and haemato-oncologists. As anthracyclines save lives, the logical goal of this cooperation, besides preventing or mitigating cardiotoxicity, is to promote an acceptable balance between the potential cardiac side effects and the vital benefit of anticancer treatment. This manuscript, which is specifically addressed to the cardiologist who has not accumulated much experience in the field of cancer therapy, focuses on several topics, that is old and new mechanisms of cardiac toxicity, late cardiac toxicity, the importance of overall risk assessment, the key role of a cardiology consult before starting cancer therapy, and the pros and cons of primary and secondary prevention programmes.
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Affiliation(s)
- Paolo Spallarossa
- aClinic of Cardiovascular Diseases, IRCCS San Martino IST, Genoa bDivision of Cardiology, Istituto Nazionale per lo Studio e la Cura dei Tumori 'Fondazione Giovanni Pascale' - IRCCS, Naples cDepartment of Medical Sciences 'Mario Aresu', University of Cagliari dInstitute of Cardiology, Center of Excellence on Aging, 'G. d'Annunzio' University, Chieti eCardiology Unit, University Hospital of Ferrara, Ferrara fDepartment of General Surgery and Medical-Surgery Specialties, University of Catania, Catania gChair and Division of Cardiology, University of Palermo, Palermo hDepartment of Clinical and Biological Sciences, University of Turin, Orbassano iU.O.C. Magnetic Resonance Imaging, Fondazione G. Monasterio C.N.R., Pisa jDepartment of Translational Medical Sciences, Federico II University, Naples kU.O.C. Cardiology Intensive Unit, A.O.U. Policlinico 'G. Martino', University of Messina, Messina, Italy
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Jeong D, Patel A, Francois CJ, Gage KL, Fradley MG. Cardiac Magnetic Resonance Imaging in Oncology. Cancer Control 2018; 24:147-160. [PMID: 28441369 DOI: 10.1177/107327481702400207] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Cardiac magnetic resonance imaging (MRI) is emerging as an important diagnostic modality in the management of cardiovascular-related dysfunction in oncological diseases. Advances in imaging techniques have enhanced the detection and evaluation of cardiac masses; meanwhile, innovative applications have created a growing role for cardiac MRI for the management of cardiotoxicity caused by cancer therapies. METHODS An overview is provided of the clinical indications and technical considerations of cardiac MRI. Its role in the evaluation of cardiac masses and cardiac function is reviewed, and novel sequences are discussed that are giving rise to future directions in cardio-oncology research. A review of the literature was also performed, focusing on cardiac MRI findings associated with cardiac dysfunction related to cancer treatment. RESULTS Cardiac MRI can be used to differentiate benign and malignant primary cardiac tumors, metastatic disease, and pseudotumors with high spatial and temporal resolution. Cardiac MRI can also be used to detect the early and long-term effects of cardiotoxicity related to cancer therapy. This is accomplished through a multiparametric approach that uses conventional bright blood, dark blood, and postcontrast sequences while also considering the applicability of newer T1 and T2 mapping sequences and other emerging techniques. CONCLUSIONS Cardio-oncology programs have an expanding presence in the multidisciplinary approach of cancer care. Consequently, knowledge of cardiac MRI and its potential applications is critical to the success of contemporary cancer diagnostics and cancer management.
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Affiliation(s)
- Daniel Jeong
- Department of Radiology, Moffitt Cancer Center, Tampa, FL.
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44
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Tadic M, Genger M, Baudisch A, Kelle S, Cuspidi C, Belyavskiy E, Burkhardt F, Venneri L, Attanasio P, Pieske B. Left Ventricular Strain in Chemotherapy-Naive and Radiotherapy-Naive Patients With Cancer. Can J Cardiol 2017; 34:281-287. [PMID: 29395702 DOI: 10.1016/j.cjca.2017.11.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 11/26/2017] [Accepted: 11/26/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND We sought to investigate left ventricular (LV) function and mechanics in patients with cancer before they received chemotherapy or radiotherapy, as well as the relationship between cancer and reduced LV multidirectional strain in the whole study population. METHODS The retrospective study involved 122 chemotherapy- and radiotherapy-naive patients with cancer and 45 age- and sex-matched controls with a cardiovascular risk profile similar to that of the patients with cancer. All the patients underwent echocardiographic examination before introduction of chemotherapy or radiotherapy. RESULTS LV longitudinal (-19.1% ± 2.1% vs -17.8% ± 3.5%; P = 0.022), circumferential (-22.9% ± 3.5% vs -20.1% ± 4.1%; P < 0.001), and radial (40.5% ± 8.8% vs 35.2% ± 10.7%; P = 0.004) strain was significantly lower in the patients with cancer than in the control group. Endocardial and midmyocardial longitudinal LV strain was significantly reduced in the patients with cancer compared with the controls, whereas epicardial longitudinal strain was similar between these groups. Endocardial, midmyocardial, and epicardial circumferential strain was significantly lower in the chemotherapy- or radiotherapy-naive patients with cancer than in the controls. Cancer was associated with reduced longitudinal (odds ratio [OR], 9.0; 95% confidence interval [CI], 2.20-23.50; P < 0.001), reduced circumferential (OR, 7.1; 95% CI, 3.80-20.40; P < 0.001), and reduced radial strain (OR, 7.2; 95% CI, 3.41-25.10; P < 0.001) independent of age, sex, body mass index, diabetes, and hypertension. CONCLUSIONS LV mechanics was impaired in the patients with cancer compared with the controls even before initiation of chemotherapy and radiotherapy. Cancer and hypertension were associated with reduced LV multidirectional strain independent of other clinical parameters. The present results indicate that cancer itself potentially induces cardiac remodelling independent of chemotherapy and radiotherapy.
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Affiliation(s)
- Marijana Tadic
- Department of Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany.
| | - Martin Genger
- Department of Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
| | - Ana Baudisch
- Department of Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
| | - Sebastian Kelle
- Department of Cardiology, DeutschesHerzzentrum Berlin (DHZB), Berlin, Germany
| | - Cesare Cuspidi
- Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy
| | - Evgeny Belyavskiy
- Department of Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
| | - Franziska Burkhardt
- Department of Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
| | - Lucia Venneri
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom
| | - Philipp Attanasio
- Department of Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
| | - Burkert Pieske
- Department of Cardiology, Charité-University-Medicine Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Berlin/Charité, Berlin, Germany; Department of Cardiology, DeutschesHerzzentrum Berlin (DHZB), Berlin, Germany
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45
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Nguyen KL, Hu P, Ennis DB, Shao J, Pham KA, Chen JJ. Cardiac MRI: a Translational Imaging Tool for Characterizing Anthracycline-Induced Myocardial Remodeling. Curr Oncol Rep 2017; 18:48. [PMID: 27292153 DOI: 10.1007/s11912-016-0533-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Cardiovascular side effects of cancer therapeutics are the leading causes of morbidity and mortality in cancer survivors. Anthracyclines (AC) serve as the backbone of many anti-cancer treatment strategies, but dose-dependent myocardial injury limits their use. Cumulative AC exposure can disrupt the dynamic equilibrium of the myocardial microarchitecture while repeated injury and repair leads to myocyte loss, interstitial myocardial fibrosis, and impaired contractility. Although children are assumed to have greater myocardial plasticity, AC exposure at a younger age portends worse prognosis. In older patients, there is lower overall survival once they develop cardiovascular disease. Because aberrations in the myocardial architecture predispose the heart to a decline in function, early detection with sensitive imaging tools is crucial and the implications for resource utilization are substantial. As a comprehensive imaging modality, cardiac magnetic resonance (CMR) imaging is able to go beyond quantification of ejection fraction and myocardial deformation to characterize adaptive microstructural and microvascular changes that are important to myocardial tissue health. Herein, we describe CMR as an established translational imaging tool that can be used clinically to characterize AC-associated myocardial remodeling.
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Affiliation(s)
- Kim-Lien Nguyen
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. .,Division of Cardiology, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, MC 111E, Los Angeles, CA, 90024, USA.
| | - Peng Hu
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Daniel B Ennis
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jiaxin Shao
- Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,Department of Radiological Sciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kimberly A Pham
- Division of Cardiology, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, MC 111E, Los Angeles, CA, 90024, USA
| | - Joseph J Chen
- Division of Cardiology, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, MC 111E, Los Angeles, CA, 90024, USA
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Mavrogeni S, Apostolou D, Argyriou P, Velitsista S, Papa L, Efentakis S, Vernardos E, Kanoupaki M, Kanoupakis G, Manginas A. T1 and T2 Mapping in Cardiology: “Mapping the Obscure Object of Desire”. Cardiology 2017; 138:207-217. [DOI: 10.1159/000478901] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/21/2017] [Indexed: 12/24/2022]
Abstract
The increasing use of cardiovascular magnetic resonance (CMR) is based on its capability to perform biventricular function assessment and tissue characterization without radiation and with high reproducibility. The use of late gadolinium enhancement (LGE) gave the potential of non-invasive biopsy for fibrosis quantification. However, LGE is unable to detect diffuse myocardial disease. Native T1 mapping and extracellular volume fraction (ECV) provide knowledge about pathologies affecting both the myocardium and interstitium that is otherwise difficult to identify. Changes of myocardial native T1 reflect cardiac diseases (acute coronary syndromes, infarction, myocarditis, and diffuse fibrosis, all with high T1) and systemic diseases such as cardiac amyloid (high T1), Anderson-Fabry disease (low T1), and siderosis (low T1). The ECV, an index generated by native and post-contrast T1 mapping, measures the cellular and extracellular interstitial matrix (ECM) compartments. This myocyte-ECM dichotomy has important implications for identifying specific therapeutic targets of great value for heart failure treatment. On the other hand, T2 mapping is superior compared with myocardial T1 and ECM for assessing the activity of myocarditis in recent-onset heart failure. Although these indices can significantly affect the clinical decision making, multicentre studies and a community-wide approach (including MRI vendors, funding, software, contrast agent manufacturers, and clinicians) are still missing.
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47
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Cardiac Imaging: Multimodality Advances and Surveillance Strategies in Detection of Cardiotoxicity. Curr Oncol Rep 2017; 19:63. [PMID: 28791609 DOI: 10.1007/s11912-017-0622-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Contemporary cancer management has increased the overall number of cancer survivors, but cardiotoxicity remains a subject of concern, which is a major cause of noncancer mortality among survivors. Among the potential cardiovascular complications, left ventricular (LV) systolic dysfunction is a poor prognostic factor. The importance of its early detection is based on the principle that the likelihood of response to heart failure (HF) treatment is temporally related to the initiation of HF treatment. For these reasons, cardiac monitoring is commonly applied in general practice, based on serial measurements of LV ejection fraction (LVEF); transthoracic echocardiography (TTE) is generally used. However, the LVEF, as a diagnostic and predictive parameter, has significant limitations, which calls for more effective multimodality imaging strategies. This approach requires further study, but there is increasing available data in the literature, encouraging the combination of multimodality imaging parameters and techniques for early cancer therapeutic-related cardiac dysfunction (CTRCD) detection.
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48
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Meléndez GC, Sukpraphrute B, D'Agostino RB, Jordan JH, Klepin HD, Ellis L, Lamar Z, Vasu S, Lesser G, Burke GL, Weaver KE, Ntim WO, Hundley WG. Frequency of Left Ventricular End-Diastolic Volume-Mediated Declines in Ejection Fraction in Patients Receiving Potentially Cardiotoxic Cancer Treatment. Am J Cardiol 2017; 119:1637-1642. [PMID: 28341361 DOI: 10.1016/j.amjcard.2017.02.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 01/02/2023]
Abstract
We sought to determine the frequency by which decreases in left ventricular (LV) end-diastolic volume (LVEDV) with and without increases in end-systolic volume (LVESV) influenced early cancer treatment-associated declines in LV ejection fraction (LVEF) or LV mass. One hundred twelve consecutively recruited subjects (aged 52 ± 14 years) with cancer underwent blinded cardiovascular magnetic resonance measurements of LV volumes, mass, and LVEF before and 3 months after initiating potentially cardiotoxic chemotherapy (72% of participants received anthracyclines). Twenty-six participants developed important declines in LVEF of >10% or to values <50% at 3 months, in whom 19% versus 60%, respectively, experienced their decline in LVEF due to isolated declines in LVEDV versus an increase in LVESV; participants who dropped their LVEF due to decreases in LVEDV lost more LV mass than those who dropped their LVEF due to an increase in LVESV (p = 0.03). Nearly one fifth of subjects experience marked LVEF declines due to an isolated decline in LVEDV after initiating potentially cardiotoxic chemotherapy. Because reductions in intravascular volume (which could be treated by volume repletion) may account for LVEDV-related declines in LVEF, these data indicate that LV volumes should be reviewed along with LVEF when acquiring imaging studies for cardiotoxicity during the treatment for cancer.
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Affiliation(s)
- Giselle C Meléndez
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, School of Medicine, Winston-Salem, North Carolina; Section of Comparative Medicine, Department of Pathology, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | - Bunyapon Sukpraphrute
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | - Ralph B D'Agostino
- Department of Biostatistical Sciences, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | - Jennifer H Jordan
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | - Heidi D Klepin
- Department of Hematology and Oncology, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | - Leslie Ellis
- Department of Hematology and Oncology, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | - Zanetta Lamar
- Department of Hematology and Oncology, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | - Sujethra Vasu
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | - Glenn Lesser
- Department of Hematology and Oncology, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | - Gregory L Burke
- Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | - Kathryn E Weaver
- Division of Public Health Sciences, Department of Social Sciences and Health Policy, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | - William O Ntim
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, School of Medicine, Winston-Salem, North Carolina
| | - W Gregory Hundley
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University, School of Medicine, Winston-Salem, North Carolina; Department of Radiological Sciences, Wake Forest University, School of Medicine, Winston-Salem, North Carolina.
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49
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Jordan JH, Vasu S, Morgan TM, D'Agostino RB, Meléndez GC, Hamilton CA, Arai AE, Liu S, Liu CY, Lima JAC, Bluemke DA, Burke GL, Hundley WG. Anthracycline-Associated T1 Mapping Characteristics Are Elevated Independent of the Presence of Cardiovascular Comorbidities in Cancer Survivors. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.115.004325. [PMID: 27502058 DOI: 10.1161/circimaging.115.004325] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 06/24/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND Cardiovascular magnetic resonance T1 mapping characteristics are elevated in adult cancer survivors; however, it remains unknown whether these elevations are related to age or presence of coincident cardiovascular comorbidities. METHODS AND RESULTS We performed blinded cardiovascular magnetic resonance analyses of left ventricular T1 and extracellular volume (ECV) fraction in 327 individuals (65% women, aged 64±12 years). Thirty-seven individuals had breast cancer or a hematologic malignancy but had not yet initiated their treatment, and 54 cancer survivors who received either anthracycline-based (n=37) or nonanthracycline-based (n=17) chemotherapy 2.8±1.3 years earlier were compared with 236 cancer-free participants. Multivariable analyses were performed to determine the association between T1/ECV measures and variables associated with myocardial fibrosis. Age-adjusted native T1 was elevated pre- (1058±7 ms) and post- (1040±7 ms) receipt of anthracycline chemotherapy versus comparators (965±3 ms; P<0.0001 for both). Age-adjusted ECV, a marker of myocardial fibrosis, was elevated in anthracycline-treated cancer participants (30.4±0.7%) compared with either pretreatment cancer (27.8±0.7%; P<0.01) or cancer-free comparators (26.9±0.2%; P<0.0001). T1 and ECV of nonanthracycline survivors were no different than pretreatment survivors (P=0.17 and P=0.16, respectively). Native T1 and ECV remained elevated in cancer survivors after accounting for demographics (including age), myocardial fibrosis risk factors, and left ventricular ejection fraction or myocardial mass index (P<0.0001 for all). CONCLUSIONS Three years after anthracycline-based chemotherapy, elevations in myocardial T1 and ECV occur independent of underlying cancer or cardiovascular comorbidities, suggesting that imaging biomarkers of interstitial fibrosis in cancer survivors are related to prior receipt of a potentially cardiotoxic cancer treatment regimen.
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Affiliation(s)
- Jennifer H Jordan
- From the Department of Internal Medicine, Section on Cardiovascular Medicine (J.H.J., S.V., G.C.M., W.G.H.), Department of Public Health Sciences (T.M.M., R.B.D., G.L.B.), Department of Pathology, Section on Comparative Medicine (G.C.M.), Department of Biomedical Engineering (C.A.H.), and Department of Radiological Sciences (W.G.H.), Wake Forest School of Medicine, Winston-Salem, NC; National Heart, Lung and Blood Institute (A.E.A.), Radiology and Imaging Sciences (S.L.), National Institutes of Health, Bethesda, MD; and Department of Radiology, Johns Hopkins University, Baltimore, MD (C.-Y.L., J.A.C.L., D.A.B.)
| | - Sujethra Vasu
- From the Department of Internal Medicine, Section on Cardiovascular Medicine (J.H.J., S.V., G.C.M., W.G.H.), Department of Public Health Sciences (T.M.M., R.B.D., G.L.B.), Department of Pathology, Section on Comparative Medicine (G.C.M.), Department of Biomedical Engineering (C.A.H.), and Department of Radiological Sciences (W.G.H.), Wake Forest School of Medicine, Winston-Salem, NC; National Heart, Lung and Blood Institute (A.E.A.), Radiology and Imaging Sciences (S.L.), National Institutes of Health, Bethesda, MD; and Department of Radiology, Johns Hopkins University, Baltimore, MD (C.-Y.L., J.A.C.L., D.A.B.)
| | - Timothy M Morgan
- From the Department of Internal Medicine, Section on Cardiovascular Medicine (J.H.J., S.V., G.C.M., W.G.H.), Department of Public Health Sciences (T.M.M., R.B.D., G.L.B.), Department of Pathology, Section on Comparative Medicine (G.C.M.), Department of Biomedical Engineering (C.A.H.), and Department of Radiological Sciences (W.G.H.), Wake Forest School of Medicine, Winston-Salem, NC; National Heart, Lung and Blood Institute (A.E.A.), Radiology and Imaging Sciences (S.L.), National Institutes of Health, Bethesda, MD; and Department of Radiology, Johns Hopkins University, Baltimore, MD (C.-Y.L., J.A.C.L., D.A.B.)
| | - Ralph B D'Agostino
- From the Department of Internal Medicine, Section on Cardiovascular Medicine (J.H.J., S.V., G.C.M., W.G.H.), Department of Public Health Sciences (T.M.M., R.B.D., G.L.B.), Department of Pathology, Section on Comparative Medicine (G.C.M.), Department of Biomedical Engineering (C.A.H.), and Department of Radiological Sciences (W.G.H.), Wake Forest School of Medicine, Winston-Salem, NC; National Heart, Lung and Blood Institute (A.E.A.), Radiology and Imaging Sciences (S.L.), National Institutes of Health, Bethesda, MD; and Department of Radiology, Johns Hopkins University, Baltimore, MD (C.-Y.L., J.A.C.L., D.A.B.)
| | - Giselle C Meléndez
- From the Department of Internal Medicine, Section on Cardiovascular Medicine (J.H.J., S.V., G.C.M., W.G.H.), Department of Public Health Sciences (T.M.M., R.B.D., G.L.B.), Department of Pathology, Section on Comparative Medicine (G.C.M.), Department of Biomedical Engineering (C.A.H.), and Department of Radiological Sciences (W.G.H.), Wake Forest School of Medicine, Winston-Salem, NC; National Heart, Lung and Blood Institute (A.E.A.), Radiology and Imaging Sciences (S.L.), National Institutes of Health, Bethesda, MD; and Department of Radiology, Johns Hopkins University, Baltimore, MD (C.-Y.L., J.A.C.L., D.A.B.)
| | - Craig A Hamilton
- From the Department of Internal Medicine, Section on Cardiovascular Medicine (J.H.J., S.V., G.C.M., W.G.H.), Department of Public Health Sciences (T.M.M., R.B.D., G.L.B.), Department of Pathology, Section on Comparative Medicine (G.C.M.), Department of Biomedical Engineering (C.A.H.), and Department of Radiological Sciences (W.G.H.), Wake Forest School of Medicine, Winston-Salem, NC; National Heart, Lung and Blood Institute (A.E.A.), Radiology and Imaging Sciences (S.L.), National Institutes of Health, Bethesda, MD; and Department of Radiology, Johns Hopkins University, Baltimore, MD (C.-Y.L., J.A.C.L., D.A.B.)
| | - Andrew E Arai
- From the Department of Internal Medicine, Section on Cardiovascular Medicine (J.H.J., S.V., G.C.M., W.G.H.), Department of Public Health Sciences (T.M.M., R.B.D., G.L.B.), Department of Pathology, Section on Comparative Medicine (G.C.M.), Department of Biomedical Engineering (C.A.H.), and Department of Radiological Sciences (W.G.H.), Wake Forest School of Medicine, Winston-Salem, NC; National Heart, Lung and Blood Institute (A.E.A.), Radiology and Imaging Sciences (S.L.), National Institutes of Health, Bethesda, MD; and Department of Radiology, Johns Hopkins University, Baltimore, MD (C.-Y.L., J.A.C.L., D.A.B.)
| | - Songtao Liu
- From the Department of Internal Medicine, Section on Cardiovascular Medicine (J.H.J., S.V., G.C.M., W.G.H.), Department of Public Health Sciences (T.M.M., R.B.D., G.L.B.), Department of Pathology, Section on Comparative Medicine (G.C.M.), Department of Biomedical Engineering (C.A.H.), and Department of Radiological Sciences (W.G.H.), Wake Forest School of Medicine, Winston-Salem, NC; National Heart, Lung and Blood Institute (A.E.A.), Radiology and Imaging Sciences (S.L.), National Institutes of Health, Bethesda, MD; and Department of Radiology, Johns Hopkins University, Baltimore, MD (C.-Y.L., J.A.C.L., D.A.B.)
| | - Chia-Ying Liu
- From the Department of Internal Medicine, Section on Cardiovascular Medicine (J.H.J., S.V., G.C.M., W.G.H.), Department of Public Health Sciences (T.M.M., R.B.D., G.L.B.), Department of Pathology, Section on Comparative Medicine (G.C.M.), Department of Biomedical Engineering (C.A.H.), and Department of Radiological Sciences (W.G.H.), Wake Forest School of Medicine, Winston-Salem, NC; National Heart, Lung and Blood Institute (A.E.A.), Radiology and Imaging Sciences (S.L.), National Institutes of Health, Bethesda, MD; and Department of Radiology, Johns Hopkins University, Baltimore, MD (C.-Y.L., J.A.C.L., D.A.B.)
| | - João A C Lima
- From the Department of Internal Medicine, Section on Cardiovascular Medicine (J.H.J., S.V., G.C.M., W.G.H.), Department of Public Health Sciences (T.M.M., R.B.D., G.L.B.), Department of Pathology, Section on Comparative Medicine (G.C.M.), Department of Biomedical Engineering (C.A.H.), and Department of Radiological Sciences (W.G.H.), Wake Forest School of Medicine, Winston-Salem, NC; National Heart, Lung and Blood Institute (A.E.A.), Radiology and Imaging Sciences (S.L.), National Institutes of Health, Bethesda, MD; and Department of Radiology, Johns Hopkins University, Baltimore, MD (C.-Y.L., J.A.C.L., D.A.B.)
| | - David A Bluemke
- From the Department of Internal Medicine, Section on Cardiovascular Medicine (J.H.J., S.V., G.C.M., W.G.H.), Department of Public Health Sciences (T.M.M., R.B.D., G.L.B.), Department of Pathology, Section on Comparative Medicine (G.C.M.), Department of Biomedical Engineering (C.A.H.), and Department of Radiological Sciences (W.G.H.), Wake Forest School of Medicine, Winston-Salem, NC; National Heart, Lung and Blood Institute (A.E.A.), Radiology and Imaging Sciences (S.L.), National Institutes of Health, Bethesda, MD; and Department of Radiology, Johns Hopkins University, Baltimore, MD (C.-Y.L., J.A.C.L., D.A.B.)
| | - Gregory L Burke
- From the Department of Internal Medicine, Section on Cardiovascular Medicine (J.H.J., S.V., G.C.M., W.G.H.), Department of Public Health Sciences (T.M.M., R.B.D., G.L.B.), Department of Pathology, Section on Comparative Medicine (G.C.M.), Department of Biomedical Engineering (C.A.H.), and Department of Radiological Sciences (W.G.H.), Wake Forest School of Medicine, Winston-Salem, NC; National Heart, Lung and Blood Institute (A.E.A.), Radiology and Imaging Sciences (S.L.), National Institutes of Health, Bethesda, MD; and Department of Radiology, Johns Hopkins University, Baltimore, MD (C.-Y.L., J.A.C.L., D.A.B.)
| | - W Gregory Hundley
- From the Department of Internal Medicine, Section on Cardiovascular Medicine (J.H.J., S.V., G.C.M., W.G.H.), Department of Public Health Sciences (T.M.M., R.B.D., G.L.B.), Department of Pathology, Section on Comparative Medicine (G.C.M.), Department of Biomedical Engineering (C.A.H.), and Department of Radiological Sciences (W.G.H.), Wake Forest School of Medicine, Winston-Salem, NC; National Heart, Lung and Blood Institute (A.E.A.), Radiology and Imaging Sciences (S.L.), National Institutes of Health, Bethesda, MD; and Department of Radiology, Johns Hopkins University, Baltimore, MD (C.-Y.L., J.A.C.L., D.A.B.).
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50
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Abstract
OPINION STATEMENT Recent advances in cancer treatment and research have greatly improved survival rates for patients with cancer. However, many of these cancer survivors are developing cardiac disease-most commonly heart failure as a result of this treatment. Certain chemotherapeutic agents, including anthracyclines and trastuzumab, have been linked to cardiotoxicity-induced cardiomyopathy in cancer patients. It has been reported as early as during infusion and as late as several years following treatment. Radiation therapy, particularly to the left breast, has also been linked to cardiac disease. The responsibility of cardiac monitoring has traditionally fallen on oncologists using assessment of LVEF through multigated acquisition (MUGA) scans or echocardiograms. The "formal" definition of cardiotoxicity, as a 5 to 10% decrease in LVEF from its baseline, even though not validated, is currently used by clinicians to alter treatment, but it has been recently challenged, as a possible irreversible late stage of a myocardial insult. Furthermore, it falls into the interobserver variability range of echocardiography. The growing field of medicine called cardio-oncology is based on emerging research that has shown that more advanced imaging modalities can help detect cardiotoxicity early, allowing the patient to receive treatment and avoid developing heart failure from cancer treatment. While traditional imaging still has its place in cardiac monitoring, cardiac magnetic resonance imaging is the most accurate and detailed imaging modality available to assess cardiotoxicity. Our own pilot cardiac MRI study suggests that a normal left ventricular remodeling to chemotherapy, when patients have not developed heart failure symptoms, could occur over time. Perhaps, knowing a baseline normal response could help us to define a more accurate definition of cardiotoxicity by CMR. Here, we discuss various imaging modalities and emerging techniques that can assist in detecting early signs of cardiotoxicity and thus reduce the incidence of cardiac disease in cancer survivors.
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Affiliation(s)
- Erick Avelar
- Division of Cardiology, Oconee Heart and Vascular Center, Augusta University/University of Georgia Medical Partnership, 2470 Daniells Bridge Road, Bldg. 200, Ste. 251, Athens, GA, 30606, USA.
| | - Caitlin R Strickland
- Oconee Heart and Vascular Center, The Exchange, 2470 Daniells Bridge Road, Bldg. 200, Suite 251, Athens, GA, 30606, USA
| | - Guido Rosito
- Division of Cardiology, UFCSPA (Universidade Federal de Ciências da Saúde de Porto Alegre), Rua Itororó 160/1305, POA, RS, 90110290, Brazil
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