Traditional and novel methods to assess and prevent chemotherapy-related cardiac dysfunction noninvasively

Abstract

The field of cardio-oncology is challenged to address an ever greater spectrum of cardiotoxicity associated with combination chemotherapy, greater dose intensity, extremes of age, and enhanced patient survival which exposes more protracted risk of developing congestive heart failure (CHF). Recent reports of chemotherapy-induced hypertension as a common adverse effect of angiogenesis inhibitors and immunosuppressants clarify the need for routine blood pressure (BP) monitoring and guideline-based management of hypertension as an integral strategy to preserve LV function. Serial monitoring of radionuclide left ventricular ejection fraction (LVEF) in adults and echocardiography in children continues to provide outcome based, cost-effective prevention of CHF in high risk patients receiving chemotherapy. To optimize treatment and monitoring strategies to eliminate late-onset LV dysfunction and CHF, traditional and novel candidate methods for assessment of chemotherapy-induced LV dysfunction are reviewed. These include serial assessment of LV volume indices by gated SPECT ERNA and gated SPECT MPI, 3D echocardiography and contrast 2D echocardiography; longitudinal strain imaging, diastolic functional parameters, 123 I-MIBG, 111 In-Antimyosin antibody imaging, and 99m Tc-Annexin V apoptosis imaging, biomarkers including troponins and BNP; genetic markers, and both functional and tissue characterization techniques with T1 weighted and T2 weighted images with cardiac magnetic resonance imaging (CMR). In our quest to optimize strategies for long-term cancer survival and prevention of CHF for patients receiving chemotherapy, rigorous modality and guideline-specific clinical outcome trials are required. A new multi-modality monitoring approach is proposed, which integrates evidencebased strengths of CMR, echocardiography, ERNA, biomarkers, and BP management for surveillance and validation of cardiotoxicity and prevention of clinical heart failure in patients receiving a broad spectrum of cancer therapies.

2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines

“…6). Ponieważ wartości referencyjne w echokardiografii i wentrykulografii radioizotopowej są różne, do początkowej i późniejszej oceny należy wykorzystywać tę samą metodę [105,106].…”

Anthracycline-induced cardiomyopathy: The search continues

“…29 The data by dos Santos suggest that MIBG imaging is not helpful in predicting who will exhibit anthracycline cardiotoxicity. Future studies will need to concentrate on other markers of the pathways that lead to cardiomyopathy.…”

Current views on anthracycline cardiotoxicity

“…Thus, if no pathological substrate can be demonstrated, cellular dysfunction alone may be hypothesized. Detection of anthracycline-related cardiomyocyte damage with indium-111 antimyosin and of impaired adrenergic neuron function with iodine-123 metaiodobenzylguanidine (MIBG) may provide early identification of patients at risk of significant myocardial dysfunction before the deterioration of LV-EF [34][35][36].…”