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Multimodality Imaging in Cardiooncology.

Pizzino F, Vizzari G, Qamar R, Bomzer C, Carerj S, Zito C, Khandheria BK - J Oncol (2015)

Bottom Line: Anthracyclines and trastuzumab are the drugs most commonly associated with development of a cardiotoxic effect.However, left ventricular ejection decrease is a delayed phenomenon, occurring after a long stage of silent myocardial damage that classic imaging methods are not able to detect.New imaging techniques including three-dimensional echocardiography, speckle tracking echocardiography, and cardiac magnetic resonance have demonstrated high sensitivity in detecting the earliest alteration of left ventricular function associated with future development of chemotherapy-induced cardiomyopathy.

View Article: PubMed Central - PubMed

Affiliation: Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Via Consolare Valeria No. 12, 98100 Messina, Italy.

ABSTRACT
Cardiotoxicity represents a rising problem influencing prognosis and quality of life of chemotherapy-treated patients. Anthracyclines and trastuzumab are the drugs most commonly associated with development of a cardiotoxic effect. Heart failure, myocardial ischemia, hypertension, myocarditis, and thrombosis are typical manifestation of cardiotoxicity by chemotherapeutic agents. Diagnosis and monitoring of cardiac side-effects of cancer treatment is of paramount importance. Echocardiography and nuclear medicine methods are widely used in clinical practice and left ventricular ejection fraction is the most important parameter to asses myocardial damage secondary to chemotherapy. However, left ventricular ejection decrease is a delayed phenomenon, occurring after a long stage of silent myocardial damage that classic imaging methods are not able to detect. New imaging techniques including three-dimensional echocardiography, speckle tracking echocardiography, and cardiac magnetic resonance have demonstrated high sensitivity in detecting the earliest alteration of left ventricular function associated with future development of chemotherapy-induced cardiomyopathy. Early diagnosis of cardiac involvement in cancer patients can allow for timely and adequate treatment management and the introduction of cardioprotective strategies.

No MeSH data available.


Related in: MedlinePlus

Bull's eyes showing a decrease of global and regional strain in a patient before (a) and after (b) treatment with chemotherapy. In the same patient the left ventricular ejection fraction was not significantly altered (see also Supplementary Videos 3 and 4).
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fig2: Bull's eyes showing a decrease of global and regional strain in a patient before (a) and after (b) treatment with chemotherapy. In the same patient the left ventricular ejection fraction was not significantly altered (see also Supplementary Videos 3 and 4).

Mentions: Two-dimensional speckle tracking echocardiography (2D-STE) analyzes the myocardial deformation on two-dimensional images by tracking natural acoustic reflections and interference patterns, called “speckle.” The software is able to provide the percentage of distance variation (deformation) between speckles within a predefined region of interest, obtaining a value defined as “strain.” The velocity of the deformation is defined “strain rate.” 2D-STE provides an accurate definition of longitudinal, circumferential, and radial component of the ventricular deformation. Twist, untwist, and torsion are additional parameters that evaluate the torsional deformation of the left ventricle. Strain evaluated by 2D-STE detected early myocardial dysfunction in chemotherapy-treated patients [38, 39] (Figure 2 and Videos 3 and 4). The application of strain and strain rate to cardiotoxicity detection has been evaluated in several relatively small studies. Global longitudinal strain (GLS) appears to be the most sensitive parameter of deformation for the detection of early systolic dysfunction. Negishi demonstrated that, in 81 patients treated for breast cancer, GLS rate and early diastolic strain rate were significantly decreased at 6 months from treatment, in comparison to baseline value in 30% of patients who developed cardiotoxicity at 12 months. GLS percentage variation was the strongest predictor of cardiotoxicity (area under the curve, 0.84) and a reduction >11% was the optimal cut-off (sensitiveness 65%, specificity 94%) [40]. Similar results have been reported by Plana showing that a decrease of >9% in GLS after the third cycle of epirubicin was the best independent and accurate predictor of cardiotoxicity (sensitiveness 84%, specificity 80%; P = 0.0001) in a sample of cancer treated patients [26]. Stoodley showed a correlation between reduction of GLS and cumulative dose of anthracyclines [41]. Thavendiranathan [42] collected the fragmentary data from several studies and reported the results in a comprehensive, systematic review. The authors established that the percentage of change is a better indicator than a defined cut-off because of the variable baseline values. A variation in GLS ranging from 10% to 15% was the best predictor of future development of cardiotoxicity. Negishi established in 81 women treated with trastuzumab that GLS decrease can predict cardiotoxicity and an 11% reduction was the optimal cut-off (confidence interval 8.3%–14.6%) [40]. According to these findings, the recent consensus document released by the American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) defined that a variation in GLS >15% is strongly predictive of future development of cardiotoxicity, while a variation <8% is not significant [26]. An important limitation associated with the use of STE is represented by differences in the deformation values provided by software from different vendors [43]. Waiting for a full standardization of the measurement, the recommendation is to evaluate the patients with the same software during the follow-up.


Multimodality Imaging in Cardiooncology.

Pizzino F, Vizzari G, Qamar R, Bomzer C, Carerj S, Zito C, Khandheria BK - J Oncol (2015)

Bull's eyes showing a decrease of global and regional strain in a patient before (a) and after (b) treatment with chemotherapy. In the same patient the left ventricular ejection fraction was not significantly altered (see also Supplementary Videos 3 and 4).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4537747&req=5

fig2: Bull's eyes showing a decrease of global and regional strain in a patient before (a) and after (b) treatment with chemotherapy. In the same patient the left ventricular ejection fraction was not significantly altered (see also Supplementary Videos 3 and 4).
Mentions: Two-dimensional speckle tracking echocardiography (2D-STE) analyzes the myocardial deformation on two-dimensional images by tracking natural acoustic reflections and interference patterns, called “speckle.” The software is able to provide the percentage of distance variation (deformation) between speckles within a predefined region of interest, obtaining a value defined as “strain.” The velocity of the deformation is defined “strain rate.” 2D-STE provides an accurate definition of longitudinal, circumferential, and radial component of the ventricular deformation. Twist, untwist, and torsion are additional parameters that evaluate the torsional deformation of the left ventricle. Strain evaluated by 2D-STE detected early myocardial dysfunction in chemotherapy-treated patients [38, 39] (Figure 2 and Videos 3 and 4). The application of strain and strain rate to cardiotoxicity detection has been evaluated in several relatively small studies. Global longitudinal strain (GLS) appears to be the most sensitive parameter of deformation for the detection of early systolic dysfunction. Negishi demonstrated that, in 81 patients treated for breast cancer, GLS rate and early diastolic strain rate were significantly decreased at 6 months from treatment, in comparison to baseline value in 30% of patients who developed cardiotoxicity at 12 months. GLS percentage variation was the strongest predictor of cardiotoxicity (area under the curve, 0.84) and a reduction >11% was the optimal cut-off (sensitiveness 65%, specificity 94%) [40]. Similar results have been reported by Plana showing that a decrease of >9% in GLS after the third cycle of epirubicin was the best independent and accurate predictor of cardiotoxicity (sensitiveness 84%, specificity 80%; P = 0.0001) in a sample of cancer treated patients [26]. Stoodley showed a correlation between reduction of GLS and cumulative dose of anthracyclines [41]. Thavendiranathan [42] collected the fragmentary data from several studies and reported the results in a comprehensive, systematic review. The authors established that the percentage of change is a better indicator than a defined cut-off because of the variable baseline values. A variation in GLS ranging from 10% to 15% was the best predictor of future development of cardiotoxicity. Negishi established in 81 women treated with trastuzumab that GLS decrease can predict cardiotoxicity and an 11% reduction was the optimal cut-off (confidence interval 8.3%–14.6%) [40]. According to these findings, the recent consensus document released by the American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) defined that a variation in GLS >15% is strongly predictive of future development of cardiotoxicity, while a variation <8% is not significant [26]. An important limitation associated with the use of STE is represented by differences in the deformation values provided by software from different vendors [43]. Waiting for a full standardization of the measurement, the recommendation is to evaluate the patients with the same software during the follow-up.

Bottom Line: Anthracyclines and trastuzumab are the drugs most commonly associated with development of a cardiotoxic effect.However, left ventricular ejection decrease is a delayed phenomenon, occurring after a long stage of silent myocardial damage that classic imaging methods are not able to detect.New imaging techniques including three-dimensional echocardiography, speckle tracking echocardiography, and cardiac magnetic resonance have demonstrated high sensitivity in detecting the earliest alteration of left ventricular function associated with future development of chemotherapy-induced cardiomyopathy.

View Article: PubMed Central - PubMed

Affiliation: Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Azienda Ospedaliera Universitaria "Policlinico G. Martino" and Universita' degli Studi di Messina, Via Consolare Valeria No. 12, 98100 Messina, Italy.

ABSTRACT
Cardiotoxicity represents a rising problem influencing prognosis and quality of life of chemotherapy-treated patients. Anthracyclines and trastuzumab are the drugs most commonly associated with development of a cardiotoxic effect. Heart failure, myocardial ischemia, hypertension, myocarditis, and thrombosis are typical manifestation of cardiotoxicity by chemotherapeutic agents. Diagnosis and monitoring of cardiac side-effects of cancer treatment is of paramount importance. Echocardiography and nuclear medicine methods are widely used in clinical practice and left ventricular ejection fraction is the most important parameter to asses myocardial damage secondary to chemotherapy. However, left ventricular ejection decrease is a delayed phenomenon, occurring after a long stage of silent myocardial damage that classic imaging methods are not able to detect. New imaging techniques including three-dimensional echocardiography, speckle tracking echocardiography, and cardiac magnetic resonance have demonstrated high sensitivity in detecting the earliest alteration of left ventricular function associated with future development of chemotherapy-induced cardiomyopathy. Early diagnosis of cardiac involvement in cancer patients can allow for timely and adequate treatment management and the introduction of cardioprotective strategies.

No MeSH data available.


Related in: MedlinePlus