The use of cardiovascular magnetic resonance as an early non-invasive biomarker for cardiotoxicity in cardio-oncology

Abstract

Contemporary cancer therapy has resulted in significant survival gains for patients. However, many current and emerging cancer therapies have an associated risk of cardiotoxicity, either acutely or later in life. Regular cardiac screening and surveillance is recommended for patients undergoing treatment for cancer, with emphasis on the early detection of cardiotoxicity before irreversible complications develop.Cardiovascular magnetic resonance imaging is able to accurately assess cardiac structure, function, and perform advanced myocardial tissue characterisation, including perfusion, features which may facilitate the diagnosis and management of cardiotoxicity in cancer survivors. This review outlines the current standards for the diagnosis and screening of cardiotoxicity, with particular focus on current and future applications of cardiovascular magnetic resonance imaging.

Cancer treatment-related cardiac dysfunction

“…The key strategy is early detection of cardiotoxicity, via baseline cardiovascular risk assessment, monitoring during treatment and surveillance in survivorship for future development of CTRCD 10. Not all cardiotoxicity is alike, and patients should have individualised assessment of their risk benefit ratio for ongoing oncological treatment.…”

Imaging modalities to detect and track cancer treatment-related cardiovascular dysfunction

“…In addition to traditional CV risk factors, atherosclerotic processes can be accelerated by chemotherapy, RT and immune checkpoint inhibitor (ICI) in patients with cancer (38). Aside from traditional treadmill and vasodilator stress single photon emission tomography (SPECT) (39), stress echocardiography (38), stress CMR (40), computed tomography angiography (CTA) (41) and PET (39) are alternative evaluation tools for ischemia in patients receiving therapies that may cause vasospasms or accelerate atherosclerosis (26).…”

New Insights in Early Detection of Anticancer Drug-Related Cardiotoxicity Using Perfusion and Metabolic Imaging

“…Initial evaluation of LVEF and subsequent evaluation under anticancer therapy is paramount as the most guidelines for cardiotoxicity are based on LVEF impairment (2). To date, echocardiography remains the most frequently used method to detect LVEF alteration, but also by assessment of left ventricle (LV) longitudinal strain evaluation that might identify early LVEF dysfunction (3).…”