A Pilot Study of Cardiac MRI in Breast Cancer Survivors After Cardiotoxic Chemotherapy and Three-Dimensional Conformal Radiotherapy

Bergom, Carmen; Rubenstein, Jason; Wilson, J. Frank; Welsh, Aimee; Ibrahim, El-Sayed H.; Prior, Phillip; Schottstaedt, A.M.; Eastwood, Daniel; Zhang, Mei‐Jie; Currey, Adam; Puckett, Lindsay; Strande, Jennifer L.; Bradley, Julie A.; White, Julia

doi:10.3389/fonc.2020.506739

Cited by 11 publications

(27 citation statements)

References 80 publications

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“…LVEF stayed within normal limits in multiple studies. In 20 breast cancer patients who received 3D conformal RT (3DCRT), a median LVEF of 63% was reported at 8.3 years [45]. Similar ndings were noted for 5 HL survivors who underwent chemotherapy and proton RT with LVEF of 60% at 5 years post treatment [49].…”

Section: Iia2 Lvef Unchangedmentioning

confidence: 52%

“…Changes in other global metrics, such as global strain, have been shown to precede LVEF changes [69], with the earliest changes being noted over shorter follow-ups (e.g., 13 ± 2 months) in patients undergoing concurrent treatments (e.g., chemoradiotherapy) [52], in which the cardiotoxic effects of chemotherapy and radiotherapy may be compounded. In this review of RT effects assessed with MRI, no dosedependency was observed in global measurements, except for changes in cardiac chamber dimensions in either pediatric patients (e.g., LV diastolic volume correlated with heart/LV dose) over short follow-ups (< 2 years) [55], who are more susceptible to radiation damage [20], or in patients undergoing concurrent treatment over longer follow-ups (e.g., LV mass index correlation with LV mean dose at > 8.3 years) [45].…”

Section: Discussionmentioning

confidence: 99%

“…Bene ts of this metric and de ned cutoffs for cardiotoxicity are that LVEF is a widely accepted and clinically utilized metric of cardiac function assessable by multiple imaging modalities (though these modalities may result in slightly different values for the same person [43]). A primary drawback is that declines in LVEF may not be observed in early MCT [44], [45] since global cardiac function may be able to compensate for mild early or focal cardiac damage. Thus, reliance on LVEF alone may delay the diagnosis and early treatment of MCT.…”

Section: Iia Left Ventricular Ejection Fraction (Lvef)mentioning

confidence: 99%

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Quantitative assessment of radiotherapy-induced myocardial damage using MRI: A systematic review

Omidi

Weiss

Trankle

et al. 2022

Preprint

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Purpose: To determine the role of magnetic resonance imaging (MRI)-based metrics to quantify myocardial toxicity following radiotherapy (RT) in human subjects through review of current literature. Methods: 21 MRI studies published between 2011-2022 were identified from available databases. Patients received chest irradiation with/without other treatments for various malignancies including breast, lung, esophageal cancer, Hodgkin’s, and non-Hodgkin’s lymphoma. In 11 longitudinal studies, the sample size, mean heart dose, and follow-up times ranged from 10-81 patients, 2.0-13.9 Gy, and 0-24 months after RT (in addition to a pre-RT assessment), respectively. In 10 cross-sectional studies, the sample size, mean heart dose, and follow-up times ranged from 5-80 patients, 2.1-22.9 Gy, and 2-24 years from RT completion, respectively. Global metrics of left ventricle ejection fraction (LVEF) and mass/dimensions of cardiac chambers were recorded, along with global/regional values of T1/T2 signal, extracellular volume (ECV), late gadolinium enhancement (LGE), and circumferential/radial/longitudinal strain. Results: LVEF tended to decline at >20 years follow-up and in patients treated with older RT techniques. Changes in global strain were observed after shorter follow-up (13±2 months) for concurrent chemoradiotherapy. In concurrent treatments with longer follow-up (8.3 years), increases in left ventricle (LV) mass index were correlated with LV mean dose. In pediatric patients, increases in LV diastolic volume were correlated with heart/LV dose at 2 years post-RT. Regional changes were observed earlier post-RT. Dose-dependent responses were reported for several parameters, including: increased T1 signal in high-dose regions, a 0.136% increase of ECV per Gy, progressive increase of LGE with increasing dose at regions receiving >30 Gy, and correlation between increases in LV scarring volume and LV mean/V10/V25 Gy dose. Conclusion: Global metrics only detected changes over longer follow-up, in older RT techniques, in concurrent treatments, and in pediatric patients. In contrast, regional measurements detected myocardial damage at shorter follow-up and in RT treatments without concurrent treatment and had greater potential for dose-dependent response. The early detection of regional changes suggests the importance of regional quantification of RT-induced myocardial toxicity at early stages, before damage becomes irreversible. Further works with homogeneous cohorts are required to examine this matter.

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Section: Iia2 Lvef Unchangedmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Section: Iia Left Ventricular Ejection Fraction (Lvef)mentioning

confidence: 99%

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Quantitative assessment of radiotherapy-induced myocardial damage using MRI: A systematic review

Omidi

Weiss

Trankle

et al. 2022

Preprint

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“…No wall motion abnormalities and no LGE were found. Similarly, Bergom et al ( 69 ) find no correlation between the mean heart irradiation dose (4.8 Gy, range 1.1–11.2 Gy) and CMR-derived LV dimensions, LVEF, LV mass, GLS and ECV in 20 breast cancer patients at 8.3 years after anthracycline chemotherapy and regional nodal irradiation with 3DCRT.…”

Section: Multimodality Cardiovascular Imaging In Radiotherapy-induced...mentioning

confidence: 94%

“…A 10, 30, 40, and 116% percentage increases in the rate of major coronary events were demonstrated in women with breast cancer and mean radiation dose to the heart < 2, 2–4, 5–9, or > 10 Gy, respectively ( 3 ). On the other hand, some of the recent studies with modern cardiac imaging techniques have failed to demonstrate significant myocardial injury, questioning the actual cardiotoxicity of modern RT regimens ( 27 , 28 , 69 , 71 ). However, there were several important differences between the outcome and the imaging studies.…”

Section: Gaps In Knowledge and Future Perspectivesmentioning

confidence: 99%

Radiotherapy-Induced Cardiotoxicity: The Role of Multimodality Cardiovascular Imaging

Podlesnikar

Berlot

Dolenc

et al. 2022

Front. Cardiovasc. Med.

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Radiotherapy (RT) is one of the pillars of cancer therapy. High-dose radiation exposure on the thorax is mainly used in the context of adjuvant RT after breast surgery, in lung and esophageal cancer, and as a complement to systemic treatment in lymphoma. Due to the anatomical proximity, the heart inevitably receives some radiation that can result in acute and chronic cardiotoxicity, leading to heart failure, coronary artery disease, pericardial and valvular heart disease. Current evidence suggests there is no safe radiation dose to the heart, which poses a need for early recognition of RT-induced cardiac injury to initiate cardioprotective treatment and prevent further damage. Multimodality cardiac imaging provides a powerful tool to screen for structural and functional abnormalities secondary to RT. Left ventricular ejection fraction, preferably with three-dimensional echocardiography or cardiovascular magnetic resonance (CMR), and global longitudinal strain with speckle-tracking echocardiography are currently the key parameters to detect cardiotoxicity. However, several novel imaging parameters are tested in the ongoing clinical trials. CMR parametric imaging holds much promise as T1, T2 mapping and extracellular volume quantification allow us to monitor edema, inflammation and fibrosis, which are fundamental processes in RT-induced cardiotoxicity. Moreover, the association between serum biomarkers, genetic polymorphisms and the risk of developing cardiovascular disease after chest RT has been demonstrated, providing a platform for an integrative screening approach for cardiotoxicity. The present review summarizes contemporary evidence of RT-induced cardiac injury obtained from multimodality imaging—echocardiography, cardiovascular computed tomography, CMR and nuclear cardiology. Moreover, it identifies gaps in our current knowledge and highlights future perspectives to screen for RT-induced cardiotoxicity.

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MRI-derived extracellular volume as a biomarker of cancer therapy cardiotoxicity: systematic review and meta-analysis

Folco,

Monti,

Zanardo

et al. 2023

Eur Radiol

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Objectives MRI-derived extracellular volume (ECV) allows characterization of myocardial changes before the onset of overt pathology, which may be caused by cancer therapy cardiotoxicity. Our purpose was to review studies exploring the role of MRI-derived ECV as an early cardiotoxicity biomarker to guide timely intervention. Materials and methods In April 2022, we performed a systematic search on EMBASE and PubMed for articles on MRI-derived ECV as a biomarker of cancer therapy cardiotoxicity. Two blinded researchers screened the retrieved articles, including those reporting ECV values at least 3 months from cardiotoxic treatment. Data extraction was performed for each article, including clinical and technical data, and ECV values. Pooled ECV was calculated using the random effects model and compared among different treatment regimens and among those who did or did not experience overt cardiac dysfunction. Meta-regression analyses were conducted to appraise which clinical or technical variables yielded a significant impact on ECV. Results Overall, 19 studies were included. Study populations ranged from 9 to 236 patients, for a total of 1123 individuals, with an average age ranging from 12.5 to 74 years. Most studies included patients with breast or esophageal cancer, treated with anthracyclines and chest radiotherapy. Pooled ECV was 28.44% (95% confidence interval, CI, 26.85−30.03%) among subjects who had undergone cardiotoxic cancer therapy, versus 25.23% (95%CI 23.31−27.14%) among those who had not (p = .003). Conclusion A higher ECV in patients who underwent cardiotoxic treatment could imply subclinical changes in the myocardium, present even before overt cardiac pathology is detectable. Clinical relevance statement The ability to detect subclinical changes in the myocardium displayed by ECV suggests its use as an early biomarker of cancer therapy–related cardiotoxicity. Key Points • Cardiotoxicity is a common adverse effect of cancer therapy; therefore, its prompt detection could improve patient outcomes. • Pooled MRI-derived myocardial extracellular volume was higher in patients who underwent cardiotoxic cancer therapy than in those who did not (28.44% versus 25.23%, p = .003). • MRI-derived myocardial extracellular volume represents a potential early biomarker of cancer therapy cardiotoxicity.

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A Pilot Study of Cardiac MRI in Breast Cancer Survivors After Cardiotoxic Chemotherapy and Three-Dimensional Conformal Radiotherapy

Cited by 11 publications

References 80 publications

Quantitative assessment of radiotherapy-induced myocardial damage using MRI: A systematic review

Quantitative assessment of radiotherapy-induced myocardial damage using MRI: A systematic review

Radiotherapy-Induced Cardiotoxicity: The Role of Multimodality Cardiovascular Imaging

MRI-derived extracellular volume as a biomarker of cancer therapy cardiotoxicity: systematic review and meta-analysis

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