Imaging methods for detection of chemotherapy-associated cardiotoxicity and dysfunction

Abstract

Survival in cancer has improved, shifting some of the focus of care to minimizing the long term complications of cancer therapy. Cardiovascular disease is a leading long-term cause of morbidity and mortality in patients who survive cancer. In the review we will focus on imaging techniques that are used to detect the cardiovascular consequences of chemotherapy. We will differentiate cardiotoxicity and cardiac injury from cardiac dysfunction and cardiomyopathy. We will discuss the current clinical measures that are used to monitor patients, the limitations of each technique, and then detail research into novel methods for tracking and detecting the cardiac toxicity and cardiac dysfunction that may occur as a result of chemotherapy.

Keywords::

• cardiac dysfunction
• cardiac magnetic resonance
• cardiotoxicity
• chemotherapy
• echocardiography
• ejection fraction
• radionuclide imaging

Financial & competing interests disclosure

TG Neilan is supported by an American Heart Association Fellow to Faculty Grant (12FTF12060588) and the National Institutes of Health (5K24HL113128-02). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Survival has dramatically improved in patients with cancer, leading to a shift in the focus of care to limiting long-term complications of cancer therapy.

• Several established and novel chemotherapy drugs are associated with cardiotoxicity.

• There is a key distinction between chemotherapy-associated cardiac dysfunction where the left ventricular ejection fraction (LVEF) is decreased and cardiotoxicity beyond a reduction in LVEF.

• Most chemotherapy-treated patients suffer some degree of cardiac injury which can go undetected due to limitations of the imaging techniques commonly used for cardiac surveillance.

• Radionuclide imaging with multigated acquisition angiogram/equilibrium radionuclide estimation of LVEF is supported by robust outcomes data but is limited by radiation exposure.

• The 2D echocardiographic measurement of LVEF is safe and widely available but limited by variability and insensitivity.

• Echocardiographic research is currently focused on strain and strain rate imaging to detect subtle early cardiac injury and dysfunction.

• Cardiac magnetic resonance is not widely available and has limited data to support its use, but offers improved accuracy and reproducibility of LVEF measurement and significant potential for tracking the underlying pathophysiological process through myocardial tissue characterization.