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Cardiac MRI: a Translational Imaging Tool for Characterizing Anthracycline-Induced Myocardial Remodeling
Kim-Lien Nguyen1,2, Peng Hu3,4, Daniel B Ennis4
1Diagnostic Cardiovascular Imaging Laboratory, David Geffen School of Medicine at UCLA and VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. klnguyen@ucla.edu.
Abstract:
Cardiovascular side effects of cancer therapeutics are the leading causes of morbidity and mortality in cancer survivors. Anthracyclines (AC) serve as the backbone of many anti-cancer treatment strategies, but dose-dependent myocardial injury limits their use. Cumulative AC exposure can disrupt the dynamic equilibrium of the myocardial microarchitecture while repeated injury and repair leads to myocyte loss, interstitial myocardial fibrosis, and impaired contractility. Although children are assumed to have greater myocardial plasticity, AC exposure at a younger age portends worse prognosis. In older patients, there is lower overall survival once they develop cardiovascular disease. Because aberrations in the myocardial architecture predispose the heart to a decline in function, early detection with sensitive imaging tools is crucial and the implications for resource utilization are substantial. As a comprehensive imaging modality, cardiac magnetic resonance (CMR) imaging is able to go beyond quantification of ejection fraction and myocardial deformation to characterize adaptive microstructural and microvascular changes that are important to myocardial tissue health. Herein, we describe CMR as an established translational imaging tool that can be used clinically to characterize AC-associated myocardial remodeling.
Insights
Anthracyclines (AC) chemotherapy can cause heart damage, leading to serious long-term effects in cancer survivors. Cardiac magnetic resonance (CMR) imaging helps detect these cardiovascular changes early, improving patient outcomes.
Area of Science:
- Cardiology
- Oncology
- Medical Imaging
Background:
- Cardiovascular side effects of cancer therapeutics, particularly anthracyclines (AC), are a major cause of morbidity and mortality in cancer survivors.
- Dose-dependent myocardial injury from AC chemotherapy disrupts cardiac microarchitecture, leading to fibrosis and impaired contractility, with worse prognosis in younger patients.
- Early detection of AC-induced cardiac remodeling is crucial for managing cardiovascular disease and improving survival in cancer patients and survivors.
Purpose of the Study:
- To highlight the clinical significance of cardiovascular side effects associated with anthracycline chemotherapy.
- To introduce cardiac magnetic resonance (CMR) imaging as a comprehensive tool for assessing myocardial health.
- To describe the utility of CMR in characterizing anthracycline-associated myocardial remodeling.
Main Methods:
- Review of existing literature on anthracycline cardiotoxicity and cardiac magnetic resonance (CMR) imaging.
- Description of CMR's capabilities in evaluating myocardial microstructural and microvascular changes beyond traditional metrics.
- Emphasis on CMR as a translational imaging tool for clinical application in cancer therapeutics' cardiovascular assessment.
Main Results:
- Anthracycline exposure leads to cumulative myocardial injury, fibrosis, and reduced contractility, impacting long-term cancer survivor health.
- Cardiac magnetic resonance (CMR) imaging provides detailed characterization of myocardial remodeling and tissue health.
- CMR can identify adaptive microstructural and microvascular changes associated with anthracycline treatment.
Conclusions:
- Cardiac magnetic resonance (CMR) imaging is an essential tool for early detection and characterization of anthracycline-induced myocardial remodeling.
- Utilizing CMR can significantly improve the management of cardiovascular complications in cancer patients undergoing anthracycline therapy.
- CMR imaging offers substantial implications for resource utilization by enabling proactive cardiovascular care in cancer survivors.
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Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...