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Subclinical cardiotoxic effects of anthracyclines as assessed by magnetic resonance imaging-a pilot study
R Wassmuth1, S Lentzsch, U Erdbruegger
1Franz-Volhard-Klinik, Charite, Humboldt- University, Berlin, Germany.
Background:
Anthracyclines are potent chemotherapeutics burdened by their cardiotoxicity. So far no marker to detect early cardiac damage exists. We tested the ability of magnetic resonance imaging (MRI) to show early changes in myocardial signal and cardiac function after anthracycline therapy.
Methods:
Twenty-two patients with normal cardiac function were investigated by MRI before and 3 and 28 days after anthracycline chemotherapy. Contrast enhanced fast spin echo images were obtained to characterize myocardial enhancement. Left ventricular ejection fraction was measured by MRI in contiguous short-axis planes.
Results:
All patients remained clinically stable. Ejection fraction decreased from 67.8% +/- 1.4% to 58.9% +/- 1.9% after 28 days (P < .05). The relative myocardial contrast enhancement increased from 3.8 +/- 0.4 to 6.9 +/- 1.1 (P < .01). An increase of the enhancement of >5 on day 3 compared with baseline predicted a significant loss of ejection fraction at 28 days (67.5% +/- 2.8% to 51.4% +/- 5.6%, mean difference 16.1% +/- 6.6%; P < .05), whereas an increase of +5 was not associated with a significant loss of ejection fraction (67.6% +/- 1.7% to 62.5% +/- 1.4%, mean difference 4.1% +/- 2.6%; P not significant).
Conclusions:
MRI detects early changes in myocardial contrast and slightly deteriorating cardiac function in patients receiving anthracyclines. Larger patient cohorts and longer follow-up are needed to evaluate MRI as a predictor for anthracycline cardiotoxicity.
Insights
Magnetic resonance imaging (MRI) can detect early cardiac damage from anthracycline chemotherapy. This method shows changes in myocardial signal and function, aiding in predicting cardiotoxicity.
Area of Science:
- Cardiology
- Oncology
- Radiology
Background:
- Anthracyclines are crucial chemotherapeutics but cause cardiotoxicity.
- Current methods lack early detection markers for anthracycline-induced cardiac damage.
Purpose of the Study:
- To evaluate magnetic resonance imaging (MRI) for detecting early myocardial signal and function changes after anthracycline therapy.
- To assess MRI's potential in predicting anthracycline cardiotoxicity.
Main Methods:
- Twenty-two patients underwent MRI before and after anthracycline chemotherapy (3 and 28 days).
- Contrast-enhanced fast spin echo imaging assessed myocardial enhancement.
- Left ventricular ejection fraction was measured using MRI.
Main Results:
- Ejection fraction decreased significantly from baseline (67.8%) to 58.9% at 28 days (P < .05).
- Myocardial contrast enhancement increased significantly from 3.8 to 6.9 (P < .01).
- An enhancement increase >5 on day 3 predicted significant ejection fraction loss at 28 days.
Conclusions:
- MRI effectively detects early myocardial contrast changes and slight cardiac function decline in patients receiving anthracyclines.
- Further research with larger cohorts and longer follow-up is necessary to validate MRI as a predictor of anthracycline cardiotoxicity.