Nuclear imaging in detection and monitoring of cardiotoxicity

Abstract

Cardiotoxicity as a result of cancer treatment is a novel and serious public health issue that has a significant impact on a cancer patient's management and outcome. The coexistence of cancer and cardiac disease in the same patient is more common because of aging population and improvements in the efficacy of antitumor agents. Left ventricular dysfunction is the most typical manifestation and can lead to heart failure. Left ventricular ejection fraction measurement by echocardiography and multigated radionuclide angiography is the most common diagnostic approach to detect cardiac damage, but it identifies a late manifestation of myocardial injury. Early non-invasive imaging techniques are needed for the diagnosis and monitoring of cardiotoxic effects. Although echocardiography and cardiac magnetic resonance are the most commonly used imaging techniques for cardiotoxicity assessment, greater attention is focused on new nuclear cardiologic techniques, which can identify high-risk patients in the early stage and visualize the pathophysiologic process at the tissue level before clinical manifestation. The aim of this review is to summarize the role of nuclear imaging techniques in the non-invasive detection of myocardial damage related to antineoplastic therapy at the reversible stage, focusing on the current role and future perspectives of nuclear imaging techniques and molecular radiotracers in detection and monitoring of cardiotoxicity.

Role of microRNAs in doxorubicin-induced cardiotoxicity: an overview of preclinical models and cancer patients

“…The assessment of cardiotoxicity onset can be achieved by means of several approaches: echocardiographic evaluation of cardiac function (usually by measuring left ventricular ejection fraction, LVEF), imaging, and endomyocardial biopsy [ 7 , 8 ]. However, these techniques present important limitations, including low sensitivity, high invasiveness, elevated costs, and late detection of heart dysfunction.…”

Cardiac Metabolic Deregulation Induced by the Tyrosine Kinase Receptor Inhibitor Sunitinib is rescued by Endothelin Receptor Antagonism

“…In fact, most imaging studies have focused on the late stages of cardiotoxicity, either because imaging was prescribed after the clinical signs became evident, or because imaging failed to detect earlier signs. Nevertheless, a few studies have shown the capacity of nuclear imaging techniques to assess early cardiotoxicity associated with anthracyclines and trastuzumab 28 . Borde et al described a higher uptake of 2'-deoxy-2'-[ 18 F]fluoro-D-glucose (FDG) in the myocardium of patients treated with adriamycin, highlighting the capacity of positron emission tomography (PET) to detect a deregulation of myocardial metabolism induced by a cancer treatment 29 .…”

Comprehensive review on cardio-oncology: Role of multimodality imaging

“…51 Gated blood-pool SPECT. Gated blood-pool SPECT allows for determination of LVEF, right ventricular EF, and wall motion abnormalities, 92 with excellent concordance with planar MUGA-derived LVEF.…”

“…51 Since clinical decisions for continuation or cessation of certain lifesaving oncologic therapy are currently based on accurate changes in LVEF, it is exceedingly important for the chosen imaging modality to be as accurate as possible, while maintaining minimal temporal variability, such that changes reflect true cardiotoxicity.…”