Cardiotoxicity detection tool for breast cancer chemotherapy: a retrospective study

Patients with breast cancer undergoing biological therapy and/or chemotherapy perform multiple radionuclide angiography (RNA) or multigated acquisition (MUGA) scans to assess cardiotoxicity. The association between RNA imaging parameters and left ventricular (LV) ejection fraction (LVEF) remains unclear.

This study aimed to extract and evaluate the association of several novel imaging biomarkers to detect changes in LVEF in patients with breast cancer undergoing chemotherapy.

We developed and optimized a novel set of MATLAB routines called the "RNA Toolbox" to extract parameters from RNA images. The code was optimized using various statistical tests (e.g., ANOVA, Bland-Altman, and intraclass correlation tests). We quantitatively analyzed the images to determine the association between these parameters using regression models and receiver operating characteristic (ROC) curves.

The code was reproducible and showed good agreement with validated clinical software for the parameters extracted from both packages. The regression model and ROC results were statistically significant in predicting LVEF (R² = 0.40, P < 0.001) (AUC = 0.78). Some time-based, shape-based, and count-based parameters were significantly associated with post-chemotherapy LVEF (β = 0.09, P < 0.001), LVEF of phase image (β = 4, P = 0.030), approximate entropy (ApEn) (β = 11.6, P = 0.001), ApEn (diastolic and systolic) (β = 39, P = 0.002) and LV systole size (β = 0.03, P = 0.010).

Despite the limited sample size, we observed evidence of associations between several parameters and LVEF. We believe that these parameters will be more beneficial than the current methods for patients undergoing cardiotoxic chemotherapy. Moreover, this approach can aid physicians in evaluating subclinical cardiac changes during chemotherapy, and in understanding the potential benefits of cardioprotective drugs.