Novel Cardiac Computed Tomography Methods for the Assessment of Anthracycline Induced Cardiotoxicity

Fehér, Attila; Baldassarre, Lauren A.; Sinusas, Albert J.

doi:10.3389/fcvm.2022.875150

Cited by 6 publications

(3 citation statements)

References 87 publications

(94 reference statements)

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“…Due to its high sensitivity in excluding CAD, CCTA is now widely used to exclude coronary stenosis in patients with exposure to cardiotoxic anticancer treatment and newly developed reduced LVEF. 45 Non-contrast CT provides information about calcium burden within the coronary arteries as a reliable predictor of cardiovascular risk 46 ; it can be used to drive cardio-protective therapy before and during cytotoxic anticancer treatment like anthracyclines as proposed by the society of Cardiovascular Computed Tomography and the Society of Thoracic Radiology. 47 …”

Section: Imaging State Of the Artmentioning

confidence: 99%

Multimodality imaging in cardio-oncology: the added value of CMR and CCTA

Lisi

Catapano

Rondi

et al. 2023

The British Journal of Radiology

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During the last 30 years, we have assisted to a great implementation in anticancer treatment with a subsequent increase of cancer survivors and decreased mortality. This has led to an ongoing interest about the possible therapy-related side-effects and their management to better guide patients therapy and surveillance in the chronic and long-term setting. As a consequence cardio-oncology was born, involving several different specialties, among which radiology plays a relevant role. Till the end of August 2022, when European Society of Cardiology (ESC) developed the first guidelines on cardio-oncology, no general indications existed to guide diagnosis and treatment of cancer therapy-related cardiovascular toxicity (CTR-CVT). They defined multimodality imaging role in primary and secondary prevention strategies, cancer treatment surveillance and early CTR-CVT identification and management. Cardiac computed tomography angiography (CCTA) has acquired a central role in coronary assessment, as far as coronary artery disease (CAD) exclusion is concerned; but on the side of this well-known application, it also started to be considered in left ventricular function evaluation, interstitial fibrosis quantification and cardiac perfusion studies. Cardiac magnetic resonance (CMR), instead, has been acknowledged as the gold standard alternative to trans-thoracic echocardiography (TTE) poor acoustic window in quantification of heart function and strain modifications, as well as pre- and post-contrast tissue characterization by means of T1-T2 mapping, early Gadolinium enhancement (EGE), late Gadolinium enhancement (LGE) and extracellular volume (ECV) evaluation. Our review is intended to provide a focus on the actual role of CMR and CCTA in the setting of a better understanding of cardiotoxicity and to draw some possible future directions of cardiac imaging in this field, starting from the recently published ESC guidelines.

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Section: Imaging State Of the Artmentioning

confidence: 99%

Multimodality imaging in cardio-oncology: the added value of CMR and CCTA

Lisi

Catapano

Rondi

et al. 2023

The British Journal of Radiology

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“…Cardiac CT is also challenged by susceptibility to gating artifacts with rapid or irregular heart rhythms, need for iodinated contrast which is limiting in patients with kidney disease, as well as less robust data on the assessment of muscle strain or mechanics that can indicate early toxicity as compared to echocardiography or cardiac MRI ( 154 ).…”

Section: Need For Improved Cardiac Imaging Approaches In the Context ...mentioning

confidence: 99%

Anthracycline-induced cardiotoxicity: From pathobiology to identification of molecular targets for nuclear imaging

Jong

Pinney

Packard

2022

Front. Cardiovasc. Med.

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Anthracyclines are a widely used class of chemotherapy in pediatric and adult cancers, however, their use is hampered by the development of cardiotoxic side-effects and ensuing complications, primarily heart failure. Clinically used imaging modalities to screen for cardiotoxicity are mostly echocardiography and occasionally cardiac magnetic resonance imaging. However, the assessment of diastolic and global or segmental systolic function may not be sensitive to detect subclinical or early stages of cardiotoxicity. Multiple studies have scrutinized molecular nuclear imaging strategies to improve the detection of anthracycline-induced cardiotoxicity. Anthracyclines can activate all forms of cell death in cardiomyocytes. Injury mechanisms associated with anthracycline usage include apoptosis, necrosis, autophagy, ferroptosis, pyroptosis, reactive oxygen species, mitochondrial dysfunction, as well as cardiac fibrosis and perturbation in sympathetic drive and myocardial blood flow; some of which have been targeted using nuclear probes. This review retraces the pathobiology of anthracycline-induced cardiac injury, details the evidence to date supporting a molecular nuclear imaging strategy, explores disease mechanisms which have not yet been targeted, and proposes a clinical strategy incorporating molecular imaging to improve patient management.

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“…Anthracyclines are anticancer drugs, including Adriamycin, erythromycin, and epi-amycin. They can be used to treat various types of cancer, including breast cancer, lymphoma, and leukemia ( 1 , 2 ). Although their anticancer effects are notable, numerous clinical studies have found these drugs have serious adverse effects, with cardiotoxicity particularly prominent ( 3 , 4 ).…”

Section: Introductionmentioning

confidence: 99%

Preventive use of beta-blockers for anthracycline-induced cardiotoxicity: A network meta-analysis

Liu

et al. 2022

Front. Cardiovasc. Med.

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BackgroundAnthracyclines are commonly used chemotherapeutic agents to treat malignant tumors. However, cardiotoxicity is a potentially serious adverse effect of anthracyclines. Beta-blockers may be effective in preventing anthracycline-induced cardiotoxicity (AIC). However, the lack of direct comparisons of various beta-blockers interferes with clinical decision-making. Network meta-analysis (NMA) was performed to assess the effectiveness of beta-blockers for AIC.MethodsWe searched PubMed, Embase, Web of Science, and the Cochrane Central Register of Clinical Trials. The last update was in May 2022. Randomized controlled trials (RCT) of beta-blockers for AIC were included. Four beta-blockers were selected for comparison based on the number of studies. NMA was conducted with STATA 14.0 software.ResultsA total of 10 RCTs (875 patients) met the selection criteria. NMA results showed that carvedilol was superior to bisoprolol [SMD = −0.50, 95% CI (−0.91, −0.10)] and nebivolol [SMD = −1.46, 95%CI (−2.82, −0.11)] in a delay of LVEF. The results of the cumulative probability ordering are as follows: carvedilol (83.8%) > metoprolol (71.8%) > bisoprolol (43.9%) > placebo (40.9%) > nebivolol (9.5%).ConclusionBased on the available evidence, carvedilol is the best beta-blocker for AIC, followed by metoprolol. However, additional studies with large samples should be conducted to confirm our findings.

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Novel Cardiac Computed Tomography Methods for the Assessment of Anthracycline Induced Cardiotoxicity

Cited by 6 publications

References 87 publications

Multimodality imaging in cardio-oncology: the added value of CMR and CCTA

Multimodality imaging in cardio-oncology: the added value of CMR and CCTA

Anthracycline-induced cardiotoxicity: From pathobiology to identification of molecular targets for nuclear imaging

Preventive use of beta-blockers for anthracycline-induced cardiotoxicity: A network meta-analysis

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