Magnetic Resonance Imaging to Detect Cardiovascular Effects of Cancer Therapy

Harries, Iwan; Liang, Kate; Williams, Mark; Berlot, B; Biglino, Giovanni; Lancellotti, Patrizio; Plana, Juan Carlos; Bucciarelli-Ducci, Chiara

doi:10.1016/j.jaccao.2020.04.011

Cited by 32 publications

(32 citation statements)

References 113 publications

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“…However, lymphoma survivors may have CVD without having clinical symptoms, and normal left ventricular (LV) ejection fraction does not preclude the presence of myocardial dysfunction ( 7 , 8 ). To detect early stages of late cardiotoxicity, screening for subclinical CVD through appropriate monitoring, including noninvasive cardiac imaging on transthoracic echocardiography or cardiovascular magnetic resonance (CMR), should be considered ( 1 , 9 ). Both transthoracic echocardiography and CMR are safe, nonionizing imaging modalities that are able to assess myocardial and valvular function.…”

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confidence: 99%

Detection of Subclinical Cardiovascular Disease by Cardiovascular Magnetic Resonance in Lymphoma Survivors

Velde

Janus

Bowen

et al. 2021

JACC: CardioOncology

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Background Long-term survivors of Hodgkin lymphoma (HL) and mediastinal non-Hodgkin lymphoma experience late adverse effects of radiotherapy and/or anthracycline-containing chemotherapy, leading to premature cardiovascular morbidity and mortality. Objectives The aim of this study was to identify markers for subclinical cardiovascular disease using cardiovascular magnetic resonance (CMR) in survivors of HL and non-Hodgkin lymphoma. Methods CMR was performed in 80 lymphoma survivors treated with mediastinal radiotherapy with or without anthracyclines, and results were compared with those among 40 healthy control subjects matched for age and sex. Results Of the 80 lymphoma survivors, 98% had histories of HL, the mean age was 47 ± 11 years, and 54% were male. Median radiotherapy dose was 36 Gy (interquartile range: 36-40 Gy), and radiotherapy was combined with anthracyclines in 70 lymphoma survivors (88%). Mean time between diagnosis and CMR was 20 ± 8 years. Significantly lower left ventricular (LV) ejection fraction (53% ± 5% vs 60% ± 5%; P < 0.001) and LV mass (47 ± 10 g/m 2 vs 56 ± 8 g/m 2 ; P < 0.001) and higher LV end-systolic volume (37 ± 8 mL/m 2 vs 33 ± 7 mL/m 2 ; P = 0.013) were found in lymphoma survivors. LV global strain parameters were also significantly worse in lymphoma survivors ( P < 0.02 for all). Native myocardial T1 was significantly higher in lymphoma survivors compared with healthy control subjects (980 ± 33 ms vs 964 ± 25 ms; P = 0.007), and late gadolinium enhancement was present in 11% of the survivors. Conclusions Long-term lymphoma survivors have detectable changes in LV function and native myocardial T1 on CMR. Further longitudinal studies are needed to assess the implication of these changes in relation to treatment and clinical outcome.

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confidence: 99%

Detection of Subclinical Cardiovascular Disease by Cardiovascular Magnetic Resonance in Lymphoma Survivors

Velde

Janus

Bowen

et al. 2021

JACC: CardioOncology

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“…There has been an increase in the opportunity to use multi-parametric CMR in the field of cardio-oncology not only for baseline and serial assessment of cardiac structure and function but also for myocardial tissue characteri-zation. 8,9) The use of CMR also provides a significant value for the diagnosis of immune checkpoint inhibitorsrelated myocarditis, although the absence of LGE or abnormal native T1 or T2 values in patients with a clinical suspicion cannot exclude the diagnosis of myocarditis. [18][19][20] Echocardiography continues to be the primary imaging modality, but its performance for the detection of subclinical CTRCD is inferior to that of CMR.…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac magnetic resonance (CMR) offers a superior capability of myocardial tissue characterization. 8,9) Late gadolinium enhancement (LGE) can identify myocardial edema or scarring, which is indicative of irreversible cardiac damage. The accumulation pattern of LGE in the myocardium is helpful to determine the etiology of the underlying disease, and the extent of LGE burden is correlated with the disease severity in various heart diseases.…”

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confidence: 99%

Detection of Profound Myocardial Damage by Cardiac MRI in a Patient with Severe Cardiotoxicity Induced by Anti-HER2 Therapy

et al. 2021

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Anti-HER2 therapy has greatly improved the long-term prognosis of patients with HER2-positive breast cancer. Meanwhile, by interfering with the protective effects of neuregulin-1/HER2 signaling on stressed cardiomyocytes, anti-HER2 therapy occasionally induces reversible cancer therapeutics-related cardiac dysfunction (CTRCD). Cardiac magnetic resonance (CMR) parametric mapping or myocardial feature-tracking, in combination with late gadolinium enhancement (LGE) imaging, has the potential to detect changes in the myocardium in anti-HER2 therapy-related cardiac dysfunction. Here we report a breast cancer patient who experienced lifethreatening CTRCD after treatment with trastuzumab plus pertuzumab. This case showed multiple transmural LGE-positive myocardial lesions in CMR imaging and high native T1 and T2 values in CMR parametric mapping, which was apparently more extensive than those observed in most patients with anti-HER2 therapy-related cardiac dysfunction. Consistent with profound myocardial damage indicated by CMR, her cardiac function was not fully restored despite intensive care and cardioprotective drug therapy. These findings suggest the potential usefulness of LGE imaging and parametric mapping by CMR for the assessment of myocardial injury to determine the clinical severity of anti-HER2 therapy-related cardiac dysfunction.

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“…It may provide diagnostic clues in favor of myocarditis or alternative diagnosis, it also gives us cardiac related prognostic information measuring extracellular matrix expansion of myocardium. A recent article provides excellent information related to MR to detect cardiovascular effects of cancer therapy and describes useful diagnostic sequences: 50 www.medigraphic.org.mx 1. Anatomical sequences, cine-volume and function, 2.…”

Section: Imagingmentioning

confidence: 99%