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New Insights in Early Detection of Anticancer Drug-Related Cardiotoxicity Using Perfusion and Metabolic Imaging
Farah Cadour1,2, Franck Thuny3, Joevin Sourdon1,2
1Aix-Marseille Université, CNRS, CRMBM, Marseille, France.
Abstract:
Cardio-oncology requires a good knowledge of the cardiotoxicity of anticancer drugs, their mechanisms, and their diagnosis for better management. Anthracyclines, anti-vascular endothelial growth factor (VEGF), alkylating agents, antimetabolites, anti-human epidermal growth factor receptor (HER), and receptor tyrosine kinase inhibitors (RTKi) are therapeutics whose cardiotoxicity involves several mechanisms at the cellular and subcellular levels. Current guidelines for anticancer drugs cardiotoxicity are essentially based on monitoring left ventricle ejection fraction (LVEF). However, knowledge of microvascular and metabolic dysfunction allows for better imaging assessment before overt LVEF impairment. Early detection of anticancer drug-related cardiotoxicity would therefore advance the prevention and patient care. In this review, we provide a comprehensive overview of the cardiotoxic effects of anticancer drugs and describe myocardial perfusion, metabolic, and mitochondrial function imaging approaches to detect them before over LVEF impairment.
Insights
Early detection of anticancer drug cardiotoxicity using advanced imaging techniques can prevent left ventricle ejection fraction (LVEF) impairment. This review details cardiotoxic effects and novel imaging for improved patient care.
Area of Science:
- Cardio-oncology
- Pharmacology
- Cardiovascular Imaging
Background:
- Cardio-oncology necessitates understanding anticancer drug cardiotoxicity mechanisms and diagnosis.
- Current guidelines rely on left ventricle ejection fraction (LVEF) monitoring.
- Subtle cardiotoxicity can precede LVEF decline.
Purpose of the Study:
- To review cardiotoxic effects of various anticancer drugs.
- To highlight advanced imaging techniques for early cardiotoxicity detection.
- To improve prevention and management of anticancer drug-induced cardiotoxicity.
Main Methods:
- Comprehensive literature review of cardiotoxicity mechanisms.
- Analysis of imaging modalities for myocardial perfusion, metabolism, and mitochondrial function.
- Focus on detection before overt LVEF impairment.
Main Results:
- Anticancer drugs (anthracyclines, anti-VEGF, etc.) induce cardiotoxicity via diverse cellular mechanisms.
- Microvascular and metabolic dysfunctions are early indicators.
- Advanced imaging can reveal cardiotoxicity before LVEF changes.
Conclusions:
- Early detection of cardiotoxicity is crucial for patient management.
- Myocardial perfusion, metabolic, and mitochondrial imaging offer promising early assessment tools.
- Integrating these methods can enhance cardio-oncology care and patient outcomes.
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