Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
Current Cardiovascular Imaging Reports
Published in: Current Cardiovascular Imaging Reports 6/2017

01-06-2017 | Cardiac Nuclear Imaging (A Cuocolo and M Petretta, Section Editors)

New Imaging Methods for Detection of Drug-Induced Cardiotoxicity in Cancer Patients

Authors: Lucas José Carvalho Simoni, Simone Cristina Soares Brandão

Published in: Current Cardiovascular Imaging Reports | Issue 6/2017

Login to get access

Abstract

Purpose of Review

In the last decades, there have been great advances made in cancer diagnosis and treatment, giving a reduction in mortality, an increase in survival, and a better quality of life in cancer patients. In addition, the progress made in cancer treatments has resulted in increased exposure to the cardiotoxic effects of chemotherapies. Screening for the occurrence of cardiotoxicity (CTX) is highly recommended before, during, and after the end of chemotherapy.

Recent Findings

A number of methods and diagnostic indexes have been recommended for detecting CTX and planning therapeutic strategies. Measuring left ventricular ejection fraction through a conventional echocardiogram is the most used strategy, although it is a poorly refined parameter, often detectable only in the later stages.

Summary

In this article, we will focus on new imaging methods and more specific parameters for early detection of CTX in cancer patients, including nuclear imaging techniques and molecular radiotracers, strain and speckle tracking echocardiography, three-dimensional echocardiography, and cardiac magnetic resonance.
Literature
1.
American Society of Clinical Oncology. The State of Cancer Care in America, 2015: a report by the American Society of Clinical Oncology. J Oncol Pract. 2015;11(2):79–113.CrossRef
2.
Pepe A, Pizzino F, Gargiulo P, Perrone-Filardi P, Cadeddu C, Mele D, et al. Cardiovascular imaging in the diagnosis and monitoring of cardiotoxicity: cardiovascular magnetic resonance and nuclear cardiology. J Cardiovasc Med (Hagerstown). 2016;17(Suppl 1):e45–54.CrossRef
3.
Vasu S, Hundley WG. Understanding cardiovascular injury after treatment for cancer: an overview of current uses and future directions of cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2013;15(1):66.CrossRefPubMedPubMedCentral
4.
Fallah-Rad N, Walker JR, Wassef A, Lytwyn M, Bohonis S, Fang T, et al. The utility of cardiac biomarkers, tissue velocity and strain imaging, and cardiac magnetic resonance imaging in predicting early left ventricular dysfunction in patients with human epidermal growth factor receptor II–positive breast cancer treated with adjuvant trastuzumab therapy. J Am Coll Cardiol. 2011;57(22):2263–70.CrossRefPubMed
5.
• Khakoo AY, Liu PP, Force T, Lopez-Berestein G, Jones LW, Schneider J, et al. Cardiotoxicity due to cancer therapy. Tex Heart Inst J. 2011;38:253–6. This paper provides clues to the prevention of cancer-therapy-induced cardiotoxicity and to the understanding of novel molecular-signaling pathways that are relevant to non-cancer-therapy-induced heart failure PubMedPubMedCentral
6.
Florescu M, Cinteza M, Vinereanu D. Chemotherapy-induced cardiotoxicity. Maedica (Buchar). 2013;8(1):59–67.
7.
Christian JB, Finkle JK, Ky B, Douglas PS, Gutstein DE, et al. Cardiac imaging approaches to evaluate drug-induced myocardial dysfunction. Am Heart J. 2012;164(6):846–55.CrossRefPubMedPubMedCentral
8.
Cardinale D, Colombo A, Bacchiani G, Tedeschi I, Meroni CA, Veglia F, et al. Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy. Circulation. 2015;131:1981–8.CrossRefPubMed
9.
Huang C, Zhang X, Ramil JM, et al. Juvenile exposure to anthracyclines impairs cardiac progenitor cell function and vascularization resulting in greater susceptibility to stress-induced myocardial injury in adult mice. Circulation. 2010;121(5):675–83.CrossRefPubMedPubMedCentral
10.
Yeh ET, Bickford CL. Cardiovascular complications of cancer therapy: incidence, pathogenesis, diagnosis and management. J Am Coll Cardiol. 2009;53(24):2231–47.CrossRefPubMed
11.
Ederhy S, Cohen A, Dufaitre G, et al. QT interval prolongation among patients treated with angiogenesis inhibitors. Target Oncol. 2009;4(2):89–97.CrossRefPubMed
12.
•• Armenian SH, Lacchetti C, Barac A, Carver J, Constine LS, Denduluri N, et al. Prevention and monitoring of cardiac dysfunction in survivors of adult cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol.​ 2016. In this recent clinical practice guideline from American Society of Clinical Oncology, we found important recommendations for prevention and monitoring of cardiac dysfunction in survivors of adult-onset cancers.
13.
Barac A. Yet another player in the cardio-oncology conundrum? Deciphering the role of FLT3. J Am Coll Cardiol. 2014;63(10):1020–1.CrossRefPubMed
14.
Goldhar HA, Yan AT, Ko DT, Earle CC, Tomlinson GA, Trudeau ME, et al. The temporal risk of heart failure associated with adjuvant trastuzumab in breast cancer patients: a population study. J Natl Cancer Inst.​ 2015;108(1).
15.
Angsutararux P, Luanpitpong S, Issaragrisil S. Chemotherapy-induced cardiotoxicity: overview of the roles of oxidative stress. Oxidative Med Cell Longev. 2015;2015:795602. doi:10.​1155/​2015/​795602.CrossRef
16.
•• Plana JC, Galderizi M, Barac A, Ewer MS, Ky B, Scherrer-Crosbie M, et al. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2014;27(9):911–39. It is a very useful and complete document about multimodality imaging evaluation of adult patients during and after cancer therapy CrossRefPubMed
17.
Thavendiranathan P, Poulin F, Lim K, Plana JC, Woo A, Marwick TH. Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy: a systematic review. J Am Coll Cardiol. 2014;63(25):2751–68.CrossRefPubMed
18.
Sawaya H, Sebag IA, Plana JC, Januzzi JL, Ky B, Tan TC, et al. Assessment of echocardiography and biomarkers for the extended prediction of cardiotoxicity in patients treated with anthracyclines, taxanes, and trastuzumab. Circ Cardiovasc Imaging. 2012;5(5):596–603.CrossRefPubMedPubMedCentral
19.
•• de Geus-Oei LF, Mavinkurve-Groothuis AM, Bellersen L, Gotthardt M, Oyen WJ, Kapusta L, van Laarhoven HW. Scintigraphic techniques for early detection of cancer treatment-induced cardiotoxicity. J Nucl Med Technol. 2013;41(3):170–81. This review provides an overview of recent advances of scintigraphic techniques to measure cardiotoxicity CrossRefPubMed
20.
Stokkel MP, de Wit-van der Veen LJ, Boekhout A. I-123-MIBG myocardial imaging in trastuzumab-based cardiotoxicity: the first experience. Nucl Med Commun. 2013;34(1):19–24.CrossRefPubMed
21.
Guimarães SL, Brandão SC, Andrade LR, Maia RJ, Markman FB. Cardiac sympathetic hyperactivity after chemotherapy: early sign of cardiotoxicity? Arq Bras Cardiol. 2015;105(3):228–34.PubMedPubMedCentral
22.
23.
24.
Bellenger NG, Burgess MI, Ray SG, Lahiri A, Coats AJ, Cleland JG, Pennell DJ. Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionuclide ventriculography and cardiovascular magnetic resonance. Are they interchangeable? Eur Heart J. 2000;21(16):1387–96.CrossRefPubMed
25.
Altena R, Perik PJ, van Veldhuisen DJ, de Vries EG, Gietema JA. Cardiovascular toxicity caused by cancer treatment: strategies for early detection. Lancet Oncol. 2009;10(4):391–9.CrossRefPubMed
26.
27.
Hoffmann R, Barletta G, von Bardeleben S, Vanoverschelde JL, Kasprzak J, Greis C. Analysis of left ventricular volumes and function: a multicenter comparison of cardiac magnetic resonance imaging, cine ventriculography, and unenhanced and contrast-enhanced two-dimensional and three-dimensional echocardiography. J Am Soc Echocardiogr. 2014;27(3):292–301.CrossRefPubMed
28.
Swain SM, Whaley FS, Ewer MS. Congestive heart failure in patients treated with doxorubicin: a retrospective analysis of three trials. Cancer. 2003;97(11):2869–79.CrossRefPubMed
29.
D’Alto M, Maurea S, Basso A, Varrella P, Polverino W, Bianchi U, et al. The heterogeneity of myocardial sympathetic innervation in normal subjects: an assessment by iodine-123 metaiodobenzylguanidine scintigraphy. Cardiologia. 1998;43(11):1231–6.PubMed
30.
Jacobson AF, Senior R, Cerqueira MD, Wong ND, Thomas GS, Lopez VA, et al. ADMIRE-HF investigators. Myocardial iodine-123 meta-iodobenzylguanidine imaging and cardiac events in heart failure. Results of the prospective ADMIRE-HF (AdreView Myocardial iImaging for Risk Evaluation in Heart Failure) study. J Am Coll Cardiol. 2010;55(20):2212–21.CrossRefPubMed
31.
Carrió I, Cowie MR, Yamazaki J, Udelson J, Camici PG. Cardiac sympathetic imaging with mIBG in heart failure. J Am Coll Cardiol Cardiovasc Imaging. 2010;3(1):92–100.CrossRef
32.
Bennink RJ, van den Hoff MJ, van Hemert FJ, de Bruin KM, Spijkerboer AL, Vanderheyden JL, Steinmetz N, van Eck-Smit BL. Annexin V imaging of acute doxorubicin cardiotoxicity (apoptosis) in rats. J Nucl Med. 2004;45:842–8.PubMed
33.
de Korte MA, de Vries EG, Lub-de Hooge MN, et al. 111Indium-trastuzumab visualises myocardial human epidermal growth factor receptor 2 expression shortly after anthracycline treatment but not during heart failure: a clue to uncover the mechanisms of trastuzumab-related cardiotoxicity. Eur J Cancer. 2007;43:2046–51.CrossRefPubMed
34.
Borde C, Kand P, Basu S. Enhanced myocardial fluorodeoxyglucose uptake following adriamycin-based therapy: evidence of early chemotherapeutic cardiotoxicity? World J Radiol. 2012;4(5):220–3.CrossRefPubMedPubMedCentral
35.
Oreto L, Todaro MC, Umland MM, Kramer C, Qamar R, Carerj S, et al. Use of echocardiography to evaluate the cardiac effects of therapies used in cancer treatment: what do we know? J Am Soc Echocardiogr. 2012;25(11):1141–52.CrossRefPubMed
36.
Stoddard MF, Seeger J, Liddell NF, Hadley TJ, Sullivan DM, Kupersmith J. Prolongation of isovolumetric relaxation time as assessed by Doppler echocardiography predicts doxorubicin-induced systolic dysfunction in humans. J Am Coll Cardiol. 1992;20:62–9.CrossRefPubMed
37.
Marchandise B, Schroeder E, Bosly A, Doyen C, Weynants P, Kremer R, et al. Early detection of doxorubicin cardiotoxicity: interest of Doppler echocardiographic analysis of left ventricular function during a prospective study. Eur J Echocardiogr. 2006;7:141–6.CrossRef
38.
Tan TC, Scherrer-Crosbie M. Assessing the cardiac toxicity of chemotherapeutic agents: role of echocardiography. Curr Cardiovasc Imaging Rep. 2012 Dec 1;5(6):403–9.CrossRefPubMedPubMedCentral
39.
Bergler-klein J. Strain and left ventricular volumes for predicting cardiotoxicity: a life-saving approach in anthracycline cancer treatment? Eur Heart J Cardiovasc Imaging. 2015;16:968–9.PubMed
40.
Bergler-klein J. Global longitudinal strain for predicting outcome after mitral repair or cardiac surgery: here to stay? Eur Heart J Cardiovasc Imaging. 2013;14(1):12–4.
41.
Hasselberg NE, Haugaa KH, Salvari SI, Gullestad L, Andreassen AK, Smiseth OA, et al. Left ventricular global longitudinal strain is associated with exercise capacity in failing hearts with preserved and reduced ejection fraction. Eur Heart J Cardiovasc Imaging. 2015;16:217–24.CrossRefPubMed
42.
Belém L, Salgado A, Felix A, Nascimento C. Ecocardiografia atual - Manual de novas técnicas. Rio de Janeiro: ed. Di livros; 2011.
43.
Castillo JMD. Strain cardiac. Rio de Janeiro: Ed Revinter Ltda; 2013.
44.
Almeida ALC, Gjesdal O, Mewton N, Choi E, Teixido-Tura G, Youneyama K, et al. Speckle- Tracking pela Ecocardiografia Bidimensional- Aplica- Introdução Conceitos. Rev Bras Ecocardiog Imagem Cardiovasc. 2013;26:38–49.
45.
Mousavi N, Tan T, Ali M, Halpern E, Wang L, Scherrer-Crosbie M. Echocardiographic parameters of left ventricular size and function as predictors of symptomatic heart failure in patients with a left ventricular ejection fraction of 50–59% treated with anthracyclines. Eur Heart J Cardiovasc Imaging. 2015;16(9):977–84.PubMed
46.
Voigt J, Pedrizzetti G, Lysyansky P, Marwick T, Houle H, Baumann R, et al. Definitions for a common standard for 2D speckle tracking echocardiography: consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging. Eur Heart J Cardiovasc Imaging. 2014;16(1):1–11.CrossRefPubMed
47.
Sugeng L, Mor-Avi V, Weinert L, Niel J, Ebner C, Steringer-Mascherbauer R, et al. Quantitative assessment of left ventricular size and function: side-by-side comparison of real-time three-dimensional echocardiography and computed tomography with magnetic resonance reference. Circulation. 2006;114(7):654–61.CrossRefPubMed
48.
Jenkins C, Bricknell K, Chan J, et al. Comparison of two- and three-dimensional echocardiography with sequential magnetic resonance imaging for evaluating left ventricular volume and ejection fraction over time in patients with healed myocardial infarction. Am J Cardiol. 2007;99(3):300–6.CrossRefPubMed
49.
Qi X, Cogar B, Hsiung MC, et al. Live/real time three-dimensional transthoracic echocardiographic assessment of left ventricular volumes, ejection fraction, and mass compared with magnetic resonance imaging. Echocardiography. 2007;24(2):166–73.CrossRefPubMed
50.
Thavendiranathan P, Grant AD, Negishi T, Plana JC, Popovic ZB, Marwick TH. Reproducibility of echocardiographic techniques for sequential assessment of left ventricular ejection fraction and volumes: application to patients undergoing cancer chemotherapy. J Am Coll Cardiol. 2013;61(1):77–84.CrossRefPubMed
51.
Kongbundansuk S, Hundley G. Noninvasive imaging of cardiovascular injury related to the treatment of cancer. J Am Coll Cardiol Img. 2014;7(8):824–38.CrossRef
52.
Baratta S, Damiano MA, Marchese ML, Trucco JI, Rizzo MM, Bernock F, et al. Serum markers, conventional Doppler echocardiography and two-dimensional systolic strain in the diagnosis of chemotherapy-induced myocardial toxicity. Rev Argent Cardiol. 2013;81:139–46.CrossRef
53.
Thavendiranathan P, Wintersperger B, Flamm S, Marwick T. Cardiac MRI in the assessment of cardiac injury and toxicity from cancer chemotherapy: a systematic review. Circ Cardiovasc Imaging. 2013;6(6):1080–91.CrossRefPubMed
54.
• Ylänen K, Poutanen T, Savikurki-Heikkilä P, Rinta-Kiikka I, Eerola A, Vettenranta K. Cardiac magnetic resonance imaging in the evaluation of the late effects of anthracyclines among long-term survivors of childhood cancer. J Am Coll Cardiol. 2013;61(14):1539–47. This study evaluated the left ventricular (LV) and right ventricular (RV) function and signs of focal fibrosis among long-term survivors of childhood cancer with the use of cardiac magnetic resonance (CMR) imaging. A markedly high proportion of these patients appear to have a cardiac dysfunction detectable by CMR with the RV also being involved, but without focal myocardial fibrosis CrossRefPubMed
55.
Armstrong G, Plana J, Zhang N, Srivastava D, Green D, Ness K, et al. Screening adult survivors of childhood cancer for cardiomyopathy: comparison of echocardiography and cardiac magnetic resonance imaging. J Clin Oncol. 2012;30(23):2876–84.CrossRefPubMedPubMedCentral
56.
Drafts B, Twomley K, D'Agostino R, Lawrence J, Avis N, Ellis L, et al. Low to moderate dose anthracycline-based chemotherapy is associated with early noninvasive imaging evidence of subclinical cardiovascular disease. J Am Coll Cardiol Img. 2013;6(8):877–85.CrossRef
57.
Neilan T, Coelho-Filho O, Pena-Herrera D, Shah R, Jerosch-Herold M, Francis S, et al. Left ventricular mass in patients with a cardiomyopathy after treatment with anthracyclines. Am J Cardiol. 2012;110(11):1679–86.CrossRefPubMedPubMedCentral
58.
Lunning M, Kutty S, Rome E, Li L, Padiyath A, Loberiza F, et al. Cardiac magnetic resonance imaging for the assessment of the myocardium after doxorubicin-based chemotherapy. Am J Clin Oncol. 2015;38(4):377–81.CrossRefPubMed
59.
Toro-Salazar O, Gillan E, O'Loughlin M, Burke G, Ferranti J, Stainsby J, et al. Occult cardiotoxicity in childhood cancer survivors exposed to anthracycline therapy. Circ Cardiovasc Imaging. 2013;6(6):873–80.CrossRefPubMed
60.
Doltra A, Amundsen B, Gebker R, Fleck E, Kelle S. Emerging concepts for myocardial late gadolinium enhancement MRI. Curr Cardiol Rev. 2013;9(3):185–90.CrossRefPubMedPubMedCentral
61.
Stirrat J, White J. The prognostic role of late gadolinium enhancement magnetic resonance imaging in patients with cardiomyopathy. Can J Cardiol. 2013;29(3):329–36.CrossRefPubMed
62.
Ugander M, Oki A, Hsu L, Kellman P, Greiser A, Aletras A, et al. Extracellular volume imaging by magnetic resonance imaging provides insights into overt and sub-clinical myocardial pathology. Eur Heart J. 2012;33(10):1268–78.CrossRefPubMedPubMedCentral
63.
• Tham EB, Haykowsky MJ, Chow K, Spavor M, Kaneko S, Khoo NS, et al. Diffuse myocardial fibrosis by T1-mapping in children with subclinical anthracycline cardiotoxicity: relationship to exercise capacity, cumulative dose and remodeling. J Cardiovasc Magn Reson. 2013;15:48. In children, following anthracycline therapy, myocardial T 1 values and calculated extracellular volume fraction correlated with cumulative chemotherapy dose, exercise capacity, and subtle structural remodeling. Novel measures of diffuse fibrosis may prove to be early non-invasive tissue biomarkers of chronic anthracycline cardiotoxicity in the future CrossRefPubMedPubMedCentral
64.
Neilan TG, Coelho-Filho OR, Shah RV, Feng JH, Pena-Herrera D, Mandry D, et al. Myocardial extracellular volume by cardiac magnetic resonance imaging in patients treated with anthracycline-based chemotherapy. Am J Cardiol. 2013;111(5):717–22.CrossRefPubMed
65.
Ugander M, Bagi PS, Oki AJ, Chen B, Hsu LY, Aletras AH, et al. Myocardial edema as detected by pre-contrast T1 and T2 CMR delineates area at risk associated with acute myocardial infarction. JACC Cardiovasc Imaging. 2012;5(6):596–603.CrossRefPubMedPubMedCentral
66.
Grover S, Leong D, Chakrabarty A, Joerg L, Kotasek D, Cheong K, et al. Left and right ventricular effects of anthracycline and trastuzumab chemotherapy: a prospective study using novel cardiac imaging and biochemical markers. Int J Cardiol. 2013;168(6):5465–7.CrossRefPubMed
67.
Jordan J, D'Agostino R, Hamilton C, Vasu S, Hall M, Kitzman D, et al. Longitudinal assessment of concurrent changes in left ventricular ejection fraction and left ventricular myocardial tissue characteristics after administration of cardiotoxic chemotherapies using T1-weighted and T2-weighted cardiovascular magnetic resonance. Circ Cardiovasc Imaging. 2014;7(6):872–9.CrossRefPubMedPubMedCentral
Metadata
Title
New Imaging Methods for Detection of Drug-Induced Cardiotoxicity in Cancer Patients
Authors
Lucas José Carvalho Simoni
Simone Cristina Soares Brandão
Publication date
01-06-2017
Publisher
Springer US
Published in
Current Cardiovascular Imaging Reports / Issue 6/2017
Print ISSN: 1941-9066
Electronic ISSN: 1941-9074
DOI
https://doi.org/10.1007/s12410-017-9415-3

ACC 2024 Congress Coverage

Cardiology Video

Highlights from the ACC 2024 Congress

Watch now

Watch official videos from the ACC congress summarizing key highlights from the last year in heart failure, cardiomyopathies, valvular disease, pulmonary vascular disease, and pediatric cardiology.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits