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Volume 18 Supplement 1

19th Annual SCMR Scientific Sessions

  • Walking poster presentation
  • Open Access

Cardiovascular magnetic resonance can detect occult anthracycline cardiotoxicity in adolescents and young adults cancer survivors with normal ejection fraction

  • 1,
  • 1,
  • 2, 1,
  • 4 and
  • 3, 1
Journal of Cardiovascular Magnetic Resonance201618 (Suppl 1) :Q42

https://doi.org/10.1186/1532-429X-18-S1-Q42

  • Published:

Keywords

  • Cardiovascular Magnetic Resonance
  • Late Gadolinium Enhancement
  • Left Atrial
  • Pulse Wave Velocity
  • Childhood Cancer Survivor

Background

Risk stratification and early monitoring of anthracycline-induced cardiotoxicity is crucial. It has been shown that early histopathological changes occur well before myocardial functional abnormalities can be detected. Additionally a long period of latency with clinical recovery of systolic function before the development of overt heart failure has been described, further emphasizing the importance of early recognition of cardiac injury and defining routine follow-up.

Methods

Long-term childhood cancer survivors were prospectively recruited after written informed consent. Study protocol was approved by the institutional review board. Subjects underwent a cardiovascular magnetic resonance (CMR) study on a 1.5 Tesla scanner (Philips, Best, Netherlands) with routine cine acquisition in long and short axis planes, tissue characterization with native T1 mapping and late gadolinium enhancement (LGE), selected 2D phase contrast flow imaging and 3D whole heart anatomy. Ventricular volumes, mass, and ejection fraction (EF) were obtained via standard planimetry techniques using a semiautomated commercial software (CMRtools, Imperial College, London, United Kingdom). Myocardial and left atrial (LA) strain parameters were derived from balanced SSFP cine images using dedicated software (TomTec Imaging Systems, 2D CPA MR, Cardiac Performance Analysis, Version 1.1.2.36, Unterschleissheim, Germany). LA reservoir, conduit and contractile functions were then quantified by both fractional volume changes and CMR feature tracking derived strain and strain rate. Transit times for pulse wave velocity (PWV) computations were determined using the foot-to-foot methodology.

Results

Twenty patients (mean age 18 ± 2 years) were enrolled. Twenty age-matched healthy controls (p = 0.109) were also recruited for comparison. Patients were studied after a mean anthracycline cumulative dose of 207 mg/m2, 83 months on average post-exposure. There was no significant difference between both groups in terms of volumetric analysis (table 1), with both presenting no areas of myocardial LGE. Left ventricular deformation parameters (but not LA functional indices) such as global radial strain (GRs) and strain rate (GRSr), global circumferential strain (GCs) and strain rate (GCSr), native T1 and PWV were significantly different among the two groups on both bivariate and multivariate regression analysis (p <0.001 to 0.035). GRSr (early diastole), GCSr (systole), PWV and native T1 outperform other imaging biomarkers (figure 1) in the assessment of subtle myocardial and vascular changes post-chemotherapy.
Table 1

Baseline characteristics

CHARACTERISTICS

PATIENTS

CONTROLS

p

Age, years

18 ± 2 [12-21]

19 ± 3 [12-24]

0.109

Gender, n

11 males; 9 females

12 males; 8 females

0.749

LV ejection fraction [LVEF (%)]

59 ± 3.5

61 ± 4.2

0.057

LV end-diastolic volume indexed [LVEDVi (mL/m2)]

85 ± 16.5

85 ± 14.1

0.975

LV end-systolic volume [LVESVi (mL/m2)]

35 ± 9.5

35 ± 9.1

0.946

Global circumferential strain (GCs)

-14.0 ± 3.6

-16.4 ± 3.5

0.041

Global radial strain (GRs)

17.2 ± 6.4

30.7 ± 6.9

<0.001

Global circumferential strain rate [GCSr (syst)]

-1.25 ± 0.26

-1.58 ± 0.41

0.005

Global radial strain rate peak systole [GCRSr (syst)]

0.86 ± 0.21

2.44 ± 0.5

<0.001

Global circumferential strain rate early diastole [GCSr (diast)]

1.49 ± 0.41

1.85 ± 0.52

0.022

Global radial strain rate early diastole [GRSr (diast)]

-1.61 ± 0.38

-2.21 ± 0.61

0.001

Native T1 (mid septum, ms)

1004 ± 70.6

966 ± 30.6

0.035

LA ejection fraction total (%)

66.9 ± 8.3

67.9 ± 7.8

0.692

LA conduit function (%)

41.2 ± 15.1

41.5 ± 10.6

0.928

LA booster pump function (%)

42.3 ± 9.1

44.5 ± 10.8

0.682

LA total strain (εs)

30.6 ± 8.6

30.7 ± 7.4

0.967

LA passive strain (εe)

24.1 ± 6.4

23.3 ± 5.2

0.638

LA active strain (εa)

6.5 ± 3.5

7.5 ± 3.6

0.400

LA peak positive strain rate (SRs)

1.2 ± 0.3

1.3 ± 0.4

0.430

LA peak early negative strain rate (SRe)

-1.7 ± 0.4

1.7 ± 0.4

0.941

LA peak late negative strain rate (SRa)

-0.9 ± 0.3

-1.0 ± 0.3

0.148

Pulse wave velocity [PWV (m/s)]

4.605 ± 0.51

3.742 ± 0.23

0.019

Figure 1
Figure 1

Panel 1 (A to F) depicts the PWV, T1 mapping/myocardial fibrosis analysis, LA and LV indices assessed. ROC curve (Panel 2) comparing the sensitivity and specificity of different imaging biomarkers analyzed and chemotherapy treatment.

Conclusions

CMR can detect subtle myocardial and vascular abnormalities in young cancer survivors with normal EF exposed to anthracycline chemotherapy in the months following exposure. CMR may provide the short term markers of future cardiac morbidity necessary to design safer treatment regimens for younger cancer survivors.

Authors’ Affiliations

(1)
Division of Imaging Sciences & Biomedical Engineering, King's College London British Heart Foundation Centre, London, United Kingdom
(2)
Departments of Surgery and Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
(3)
Pediatric Cardiology, University of Texas, Dallas, TX, USA
(4)
Pediatric Cardiology, Evelina London Children's Hospital/Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom

Copyright

© Vieira et al. 2016

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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