Cardiovascular Magnetic Resonance in the Oncology Patient

Jordan, Jennifer H.; Todd, Ryan M.; Vasu, Sujethra; Hundley, W. Gregory

doi:10.1016/j.jcmg.2018.06.004

Cited by 87 publications

(87 citation statements)

References 139 publications

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“…Unlike the results from mice 25 , in our model, anthracyclines had a clear cardiocytotoxic effect, and we were able to detect differences in cardiac function and cardiac contractility between animals receiving RIPC or no pretreatment. We also found differences in T1 mapping values implicated in AIC 27 . In agreement with the results from mice 25 , at the end of the study protocol we found that RIPC-treated animals had significantly less fibrosis (collagen fraction) that animals receiving no pretreatment.…”

Section: Discussionmentioning

confidence: 55%

Remote Ischemic Preconditioning Ameliorates Anthracycline-induced Cardiotoxicity and Preserves Mitochondrial Integrity

Galán‐Arriola

Villena-Gutiérrez

Higuero-Verdejo

et al. 2020

Preprint

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AimsAnthracycline-induced cardiotoxicity (AIC) is a serious adverse effect in a significant proportion of cancer patients. A central mechanism of AIC is irreversible mitochondrial damage. Despite major efforts, there are currently no effective therapies able to prevent AIC. Methods and ResultsForty Large-White pigs were included. In Study 1, 20 pigs were randomized 1:1 to remote ischemic pre-conditioning (RIPC, 3 cycles of 5 min leg ischemia followed by 5 min reperfusion) or no pretreatment. RIPC was performed immediately before each of five intracoronary doxorubicin injections (0.45 mg/kg) given at weeks 0, 2, 4, 6, and 8. A group of 10 pigs with no exposure to doxorubicin served as healthy controls. Pigs underwent serial cardiac magnetic resonance (CMR) exams at baseline and at weeks 6, 8, 12, and 16. After 16week CMR, pigs were sacrificed and tissue samples collected. In study 2, 10 new pigs received 3 doxorubicin injections (with/out preceding RIPC) and were sacrificed 2 weeks after the third dose.In Study 1, LVEF remained unchanged in doxorubicin-treated pigs until week 6 (time of the fourth doxorubicin injection). From there on, LVEF progressively declined, but LVEF depression was blunted animals receiving RIPC before doxorubicin (RIPC-Doxo), which had a significantly higher LVEF at week 16 than doxorubicin treated pigs that received no pretreatment (Untreated-Doxo) (41.5±9.1% vs 32.5±8.7%, p=0.04). Preserved LVEF was mainly due to conserved contractile function, as evidenced by smaller LVESV, and better regional contractile function. In Study 2, transmission electron microscopy (TEM) after 3 doxorubicin doses showed fragmented mitochondria with severe morphological abnormalities in RIPC+Doxo pigs, together with upregulation of fission proteins and autophagy markers on western blot. At the end of the 16-week Study 1 protocol, TEM revealed overt mitochondrial Galan-Arriola et al. Remote ischemic conditioning and Cardiotoxicity 3 fragmentation with structural fragmentation in Untreated-Doxo pigs, whereas interstitial fibrosis was significantly less severe in the RIPC+Doxo pigs. ConclusionIn a translatable large animal model of AIC, RIPC applied immediately before each doxorubicin injection resulted in preserved cardiac contractility with significantly higher longterm LVEF and less cardiac fibrosis. RIPC prevented mitochondrial fragmentation and dysregulated autophagy from the early stages of AIC. RIPC is a promising intervention for testing in clinical trials in AIC.

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Section: Discussionmentioning

confidence: 55%

Remote Ischemic Preconditioning Ameliorates Anthracycline-induced Cardiotoxicity and Preserves Mitochondrial Integrity

Galán‐Arriola

Villena-Gutiérrez

Higuero-Verdejo

et al. 2020

Preprint

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“…29,30 Early studies detected declines in LVEF after anthracycline treatment utilizing other imaging modalities such as radionuclide multiple-gated acquisition, transthoracic echocardiography (TTE), and cardiac computed tomography. 29,31,32 The advancement of MRI has delivered an accurate and reproducible test for measuring ventricular volume, mass, and ejection fraction. 27 The Simpson's method of multiple disk-derived measurements is commonly used to calculate left and right ventricular EF.…”

Section: Ventricular Dysfunctionmentioning

confidence: 99%

MRI in cardio‐oncology: A review of cardiac complications in oncologic care

Jeong

Gladish

Chițiboi

et al. 2019

Magnetic Resonance Imaging

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From detailed characterization of cardiac abnormalities to the assessment of cancer treatment‐related cardiac dysfunction, cardiac MRI is playing a growing role in the evaluation of cardiac pathology in oncology patients. Current guidelines are now incorporating the use of MRI for the comprehensive multidisciplinary approach to cancer management, and innovative applications of MRI in research are expanding its potential to provide a powerful noninvasive tool in the arsenal against cancer. This review focuses on the application of cardiac MRI to diagnose and manage cardiovascular complications related to cancer and its treatment. Following an introduction to current cardiac MRI methods and principles, this review is divided into two sections: functional cardiovascular analysis and anatomical or tissue characterization related to cancer and cancer therapeutics. Level of Evidence: 5 Technical Efficacy Stage: 1 J. Magn. Reson. Imaging 2019;50:1349–1366.

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“…4 Notably, within this analysis, we observed an earlier increase in cancer patient HF admissions, precedent to the relative increase among those without cancer. [24][25][26] Alternatively, a primary focus on cancer treatment may inadvertently lead to more advanced HF presentations resulting from decreased awareness of the severity or aetiology of the cardiovascular issues. 4,5 For example, sunitinib, a TKI with anti-vascular endothelial growth factor (VEGF) activity has been associated with up to an 8% incidence of left ventricular dysfunction and HF development.…”

Section: Heart Failure Admissions In Cancermentioning

confidence: 99%

“…For example, direct fibrotic injury after cancer-directed therapy may lead to limitations in cardiopulmonary reserve. [24][25][26] Alternatively, a primary focus on cancer treatment may inadvertently lead to more advanced HF presentations resulting from decreased awareness of the severity or aetiology of the cardiovascular issues. 27 Finally, patient and physician perceptions of both cancer prognosis and the benefits of HF treatments can affect timing of diagnosis.…”

Section: Heart Failure Admissions In Cancermentioning

confidence: 99%

Health care utilization and mortality associated with heart failure‐related admissions among cancer patients

et al. 2019

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Aims Heart failure (HF) outcomes continue to improve with widespread use of new therapies. Concurrently, cancer survival has dramatically improved. Yet whether cancer patients share similar strategies and outcomes of inpatient HF treatment to those without HF is unknown. We sought to assess the contemporary impacts of cancer on inpatient HF outcomes over time. Methods and results The retrospective National Inpatient Sample (2003–15) and National Readmissions Database (2013–14) registries were queried for adults admitted for HF and stratified for cancer status, excluding cases of metastatic disease. Temporal trends in HF admissions, hospital charge rates, length of hospitalization, HF‐related procedure utilization, in‐hospital mortality, and hospital readmissions were analysed. Over 13 years of follow‐up, there were 12 769 077 HF admissions (mean age 73 years, 50.8% female, 30.8% non‐White), among which 1 413 287 (11%) had a co‐morbid cancer diagnosis. Cancer patients were older, were predominantly male, and tended to be smokers. Over time, HF admission rates among cancer patients increased, despite a concurrent decrease among patients without cancer (P < 0.0001). After propensity matching, in‐hospital mortality was significantly higher among cancer HF patients (5.1% vs. 2.9%, P < 0.0001). Additionally, HF‐related procedure utilization was disproportionately lower among cancer patients (0.30 vs. 0.35 procedures/HF hospitalization, P < 0.001); the presence of cancer was associated with increased costs, length of hospitalizations, and all‐cause readmissions, but fewer HF readmissions (P < 0.0001, each). Conclusions While the incidence of HF hospitalizations has increased among cancer patients, they do not appear to share the same rates of advanced HF care, readmissions trends, or reductions in in‐hospital mortality. Future studies targeting modifiable factors related to these differences are needed.

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Cardiovascular Magnetic Resonance in the Oncology Patient

Cited by 87 publications

References 139 publications

Remote Ischemic Preconditioning Ameliorates Anthracycline-induced Cardiotoxicity and Preserves Mitochondrial Integrity

Remote Ischemic Preconditioning Ameliorates Anthracycline-induced Cardiotoxicity and Preserves Mitochondrial Integrity

MRI in cardio‐oncology: A review of cardiac complications in oncologic care

Health care utilization and mortality associated with heart failure‐related admissions among cancer patients

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