Anthracycline cardiotoxicity: current methods of diagnosis and possible role of 18F-FDG PET/CT as a new biomarker

Abstract

Despite advances in chemotherapy, the drugs used in cancer treatment remain rather harmful to the cardiovascular system, causing structural and functional cardiotoxic changes. Positron-emission tomography associated with computed tomography (PET/CT) has emerged like a promising technique in the early diagnosis of these adverse drug effects as the myocardial tissue uptake of fluorodeoxyglucose labeled with fluorine-18 (18F-FDG), a glucose analog, is increased after their use. Among these drugs, anthracyclines are the most frequently associated with cardiotoxicity because they promote heart damage through DNA breaks, and induction of an oxidative, proinflammatory, and toxic environment. This review aimed to present the scientific evidence available so far regarding the use of 18F-FDG PET/CT as an early biomarker of anthracycline-related cardiotoxicity. Thus, it discusses the physiological basis for its uptake, hypotheses to justify its increase in the myocardium affected by anthracyclines, importance of 18F-FDG PET/CT findings for cardio-oncology, and primary challenges of incorporating this technique in standard clinical oncology practice.

Artificial intelligence-enhanced risk stratification of cancer therapeutics-related cardiac dysfunction using electrocardiographic images

“…More recently, multimodal imaging with magnetic resonance imaging, including T1 mapping, extracellular volume (ECV) quantification, 11,14 or positron emission tomography with radiotracers tracking myocardial function, metabolism, and tissue repair have also shown value in pre-clinical or small clinical studies. 14,35,36 However, access to these technologies varies across different parts of the world, [37][38][39] underlining an unmet need for efficient cardiovascular risk stratification that can be performed at the point-of-care using readily accessible, yet personalized technologies.…”

Evolução da Captação Miocárdica de 18F-FDG em Paciente com Diagnóstico de Cardiotoxicidade

“…Apesar da resposta definitiva não estar clara na literatura, estudos sugerem que este aumento pode ser um indicador precoce de CTX. 4 - 9 …”

“…Fatores como sexo, idade, alimentação rica em carboidratos nos dias anteriores ao exame, obesidade, diabetes e algumas medicações podem influenciar o consumo miocárdico de 18 F-FDG. 9 Apesar disso, existem padrões de captação miocárdica considerados fisiológicos. 10 …”

“…Although there is no definite answer in the literature, studies have suggested that this increase may be an early indicator of cardiotoxicity. 4 - 9 …”

“…Factors like sex, age, high carbohydrate intake on the days prior to the exam, obesity, diabetes, and some medications may influence myocardial 18 F-FDG uptake. 9 Despite that, there are patterns of myocardial uptake that may be considered physiological. 10 …”