Detection of Cardiac Toxicity Due to Cancer Treatment: Role of Cardiac MRI

Abstract

Common cancer treatments including anthracycline-based chemotherapy, tyrosine kinase inhibitors, and thoracic radiation therapy can result in short- and long-term cardiovascular complications with a significant impact on morbidity and mortality. Anthracycline-based chemotherapy and tyrosine kinase inhibitors are associated with left ventricular systolic dysfunction and heart failure. Radiation therapy is associated with restrictive cardiomyopathy, coronary artery disease, as well as pericardial and valvular disease. The current standard surveillance of oncology patients for cardiotoxicity involves echocardiography, radionuclide cardiac blood pool imaging, and cardiac magnetic resonance (CMR) imaging. CMR can be used to evaluate ventricular structure and function, which is important for management decisions to prevent further cardiac injury. In patients for whom standard surveillance imaging demonstrates a drop in systolic function with or without symptoms, the use of CMR is an appropriate next step for further evaluation due to the accuracy and reproducibility of measurements of function and volumes combined with the additive information provided by tissue characterization through imaging of myocardial edema and myocardial fibrosis, although the clinical applications of these latter are as yet unclear. Overall, detection of early cardiotoxicity is important since therapeutic response is improved with prompt initiation of medical treatment.

Cardiac Imaging Methods for Chemotherapy-related Cardiotoxicity Screening and Related Radiation Exposure: Current Practice and Trends

“…A decline in left ventricular ejection fraction may be a late manifestation of cardiotoxicity (12) and there has been an increasing focus on early detection of CRC using techniques, such as strain monitoring using Echo (13) and T2-weighted imaging for myocardial edema using CMR (14). There have been algorithms proposed to incorporate these techniques into the CRC screening protocols (15).…”

Echocardiographic measures associated with the presence of left ventricular thrombus in patients with chemotherapy‐related cardiac dysfunction

“…In our study, the most important contributing factor for thrombus formation is reduced LVEF and restrictive LV filling pattern. In the context of decreased LVEF, it has been shown that anthracycline treatment can cause decreased the left ventricular mass index (LVMI) which is a surrogate marker for myocyte loss that leads to a decline in LV function . With respect to restrictive filling pattern, pathological studies have shown increased fibrosis in almost all the patients who have been treated with anthracycline .…”

“…In the context of decreased LVEF, it has been shown that anthracycline treatment can cause decreased the left ventricular mass index (LVMI) 41 which is a surrogate marker for myocyte loss that leads to a decline in LV function. 42 With respect to restrictive filling pattern, pathological studies have shown increased fibrosis in almost all the patients who have been treated with anthracycline. 43 More recently, CMR studies have reported an increased extracellular volume fraction indicating increased fibrosis from pre-to postanthracycline treatment.…”

Is it possible to cure childhood acute myeloid leukaemia without significant cardiotoxicity?

“…Other options may be 3D-echocardiography (Toro-Salazar et al, 2016), stress-echocardiography (Jarfelt et al, 2007), and nuclear (Gorla et al, 2016) or magnetic resonance imaging (Meyersohn et al, 2015), but these options are more time-consuming and will probably not provide additional information beyond what can be detected by speckle tracking echocardiography .…”