Cardiovascular magnetic resonance characterisation of anthracycline cardiotoxicity in adults with normal left ventricular ejection fraction

Harries, Iwan; Berlot, B; ffrench-Constant, Natasha; Williams, Mark; Liang, Kate; Gárate, Estefania De; Baritussio, Anna; Biglino, Giovanni; Plana, Juan Carlos; Bucciarelli-Ducci, Chiara

doi:10.1016/j.ijcard.2021.08.037

Cited by 11 publications

(9 citation statements)

References 36 publications

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“…In a study conducted by Harries et al. ( 18 ), anthracycline-treated cancer survivors with normal LVEF have significant perturbations of myocardial cell volume compared with controls.…”

Section: Discussionmentioning

confidence: 99%

“…Novel tissue characterization sequences, such as native T1 mapping and ECV estimation, have shown promise for the detection of diffuse fibrosis and inflammation/edema by quantitatively assessing its presence and extent ( 6 ). Previous studies have demonstrated that increased ECV could be identified with CMR in cancer survivors and those currently undergoing treatment ( 9 , 12 , 13 , 17 , 18 ). Our study found that ECV was elevated in cancer patients undergoing chemotherapy, which was consistent with the results of prior reports.…”

Section: Discussionmentioning

confidence: 99%

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Chemotherapy effect on myocardial fibrosis markers in patients with gynecologic cancer and low cardiovascular risk

Wang

Yang

et al. 2023

Front. Oncol.

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BackgroundPatients with gynecologic cancers experience side effects of chemotherapy cardiotoxicity. We aimed to quantify cardiac magnetic resonance (CMR) markers of myocardial fibrosis in patients with gynecologic cancer and low cardiovascular risk who undergo chemotherapy.MethodsThis study is part of a registered clinical research. CMR T1 mapping was performed in patients with gynecologic cancer and low cardiovascular risk undergoing chemotherapy. The results were compared with those of age-matched healthy control subjects.Results68 patients (median age = 50 years) and 30 control subjects were included. The median number of chemotherapy cycles of patients was 9.0 (interquartile range [IQR] 3.3–17.0). Extracellular volume fraction (ECV) (27.2% ± 2.7% vs. 24.5% ± 1.7%, P < 0.001) and global longitudinal strain (−16.2% ± 2.8% vs. −17.4% ± 2.0%, P = 0.040) were higher in patients compared with controls. Patients with higher chemotherapy cycles (>6 cycles) (n=41) had significantly lower intracellular mass indexed (ICMi) compared with both patients with lower chemotherapy cycles (≤6 cycles) (n=27) (median 27.44 g/m2 [IQR 24.03–31.15 g/m2] vs. median 34.30 g/m2 [IQR 29.93–39.79 g/m2]; P = 0.002) and the control group (median 27.44 g/m2 [IQR 24.03–31.15 g/m2] vs. median 32.79 g/m2 [IQR 27.74–35.76 g/m2]; P = 0.002). Patients with two or more chemotherapy regimens had significantly lower ICMi compared with both patients with one chemotherapy regimen (27.45 ± 5.16 g/m2 vs. 33.32 ± 6.42 g/m2; P < 0.001) and the control group (27.45 ± 5.16 g/m2 vs. 33.02 ± 5.52 g/m2; P < 0.001). The number of chemotherapy cycles was associated with an increase in the ECV (Standard regression coefficient [β] = 0.383, P = 0.014) and a decrease in the ICMi (β = -0.349, P = 0.009).ConclusionPatients with gynecologic cancer and low cardiovascular risk who undergo chemotherapy have diffuse extracellular volume expansion, which is obvious with the increase of chemotherapy cycles. Myocyte loss may be part of the mechanism in patients with a higher chemotherapy load.Clinical trial registrationhttp://www.chictr.org.cn, identifier ChiCTR-DDD-17013450.

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“…In a study conducted by Harries et al. ( 18 ), anthracycline-treated cancer survivors with normal LVEF have significant perturbations of myocardial cell volume compared with controls.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Chemotherapy effect on myocardial fibrosis markers in patients with gynecologic cancer and low cardiovascular risk

Wang

Yang

et al. 2023

Front. Oncol.

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“…Included works (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40) were published between 2013 [22,23] and 2022 [24,25], and all but 2 [26,27] had a prospective design. Six studies were conducted in the USA [22,25,[28][29][30][31], 4 in Canada [23,[32][33][34], 4 in Germany [27,[35][36][37], 2 in the Netherlands [24,38], 1 in the UK [26], 1 in Norway [39], and 1 in Japan [40].…”

Section: Data Extractionmentioning

confidence: 99%

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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“…GLS by echocardiography or CMR has been shown to correlate with diffuse myocardial fibrosis, both for the left ventricle and for the left atrium [ 40 , 41 ], but the correlation is modest at best and is difficult to apply for individual clinical decisions. Similarly, clear signs of diastolic dysfunction, such as short E wave deceleration, high E/e’ ratio, low left atrial strain, or increased systolic right ventricular pressure, are suggestive of increased diastolic LV pressures, which, in turn, are indicative of myocardial fibrosis, if other causes can be excluded.…”

Section: Structure Of the Myocardiummentioning

confidence: 99%

The Role of Novel Cardiac Imaging for Contemporary Management of Heart Failure

Flachskampf

Baron

2022

JCM

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Heart failure is becoming the central problem in cardiology. Its recognition, differential diagnosis, and the monitoring of therapy are intimately coupled with cardiac imaging. Cardiac imaging has witnessed an explosive growth and differentiation, with echocardiography continuing as the first diagnostic step; the echocardiographic exam itself has become considerably more complex than in the last century, with the assessment of diastolic left ventricular function and strain imaging contributing important information, especially in heart failure. Very often, however, echocardiography can only describe the fact of functional impairment and morphologic remodeling, whereas further clarification of the underlying disease, such as cardiomyopathy, myocarditis, storage diseases, sarcoidosis, and others, remains elusive. Here, cardiovascular magnetic resonance and perfusion imaging should be used judiciously to arrive as often as possible at a clear diagnosis which ideally enables specific therapy.

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Cardiovascular magnetic resonance characterisation of anthracycline cardiotoxicity in adults with normal left ventricular ejection fraction

Cited by 11 publications

References 36 publications

Chemotherapy effect on myocardial fibrosis markers in patients with gynecologic cancer and low cardiovascular risk

Chemotherapy effect on myocardial fibrosis markers in patients with gynecologic cancer and low cardiovascular risk

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

The Role of Novel Cardiac Imaging for Contemporary Management of Heart Failure

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