The clinical value of nuclear medicine in the assessment of irradiation-induced and anthracycline-associated cardiac damage

Abstract

Two groups of patients, those treated for Hodgkin's disease and breast cancer, are particularly at risk of developing late myocardial damage, since radiotherapy (RT) techniques for both patient groups may include (large) parts of the heart, and adjuvant systemic therapy is frequently administered to these patients, in particular anthracycline-containing chemotherapy. Available literature on the monitoring and prediction of RT-induced and anthracycline-associated cardiac damage using nuclear medicine techniques is presented. Based on relevant studies, the risk of overall cardiac disease post-RT and overt congestive heart failure during anthracycline-containing chemotherapy is probably low. Conventional nuclear medicine imaging, i.e. myocardial perfusion scintigraphy, may be of complementary use to echocardiographical evaluation for routine follow-up after RT with modern techniques, in a subgroup of patients with known cardiovascular risk factors. Left ventricle ejection fraction (LVEF) measurements, as assessed by radionuclide angiography for the monitoring of anthracycline-associated cardiac injury, are not very sensitive and early detection will probably be enhanced by combining LVEF measurements with other cardiac function parameters. Also, it may be expected that nuclear medicine techniques using molecular radioligands will constitute an essential future step in the evaluation of subclinical cardiac injury afforded by the combined effect of RT and cardiotoxic chemotherapy.

EVALUATION OF ANTHRACYCLINE-INDUCED EARLY LEFT VENTRICULAR DYSFUNCTION IN CHILDREN WITH CANCER: A Comparative Study with Echocardiography and Multigated Radionuclide Angiography

“…Their results were similiar to our findings. Many studies emphasize that LV diastolic dysfunction detected by MUGA may be an early evidence of anthracycline cardiotoxicity [3,5,20,32]. In the present study, similiar to Cottin et al [33], we found simultaneous drop in both systolic and diastolic functions with MUGA.…”

“…It is clear that cardiotoxicity will increase with higher cumulative doses [1,6,7,14]. Besides the cumulative dose mediastinal irradiation, young age at the time of treatment, preexisting heart disease, concomitant therapy with cyclophosphamide and other chemotherapeutic agents, high infusion rate of anthracycline, and female gender contribute to cardiotoxicity [1,3,14,20]. Although 3 patients in the study group had thoracic radiotherapy, doses were lower than cardiotoxic limit for irradiation [21].…”

“…Pınarlı et al [22] suggested that the enhanced LV wall stress indicates an early stage of cardiotoxicity and can be interpreted as a more sensitive index of cardiac systolic functional abnormality than EF and FS, even at low cumulative anthracycline doses. Changes in LV diastolic function can occur before LVEF falls to subnormal levels [20]. Parameters used to assess the diastolic function include the isovolemic relaxation time and the early peak flow velocity/atrial velocity (E/A) ratio [3].…”

Anticancer therapy induced cardiotoxicity: review of the literature

“…A typical manifestation is the progressive reduction of the EF leading to dilatated or restrictive cardiomyopathy [6]. This manifestation is associated with worse prognosis because of decompensation, severe arrhythmias or valve damage [57,62,63].…”

Radiation-Induced Cardiomyopathy Incidentally Detected on Oncology ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography

“…Therefore, diagnosis of radiationinduced cardiomyopathy needs multimodality assessment using echocardiography, 2 cardiac MRI, 3 and myocardial perfusion imaging. 4 Late gadolinium enhancement has been detected in half of patients who received RTx for esophageal cancer. 3 The present patient did not develop myocardial fibrosis.…”