Radiologic Diagnosis of Cardiac Injury in Patients Undergoing Systemic Anticancer Therapy
Abstract
Systemic anticancer therapy is a cornerstone of modern oncology, offering hope to millions of patients worldwide. Modern anticancer agents are associated with a broad spectrum of adverse effects, ranging from mild symptoms to life-threatening complications. Deterioration in a patient’s clinical condition is not always attributable exclusively to drug toxicity; it may also result from progression of the primary tumor, the development of secondary infections, or exacerbation of comorbid diseases. Contrast-enhanced magnetic resonance imaging plays a particularly important role in the accurate diagnosis of cardiotoxicity. Early recognition of complications and timely initiation of appropriate therapy can substantially improve the quality of life and increase the probability of favorable outcomes in cancer patients.
About the Authors
E. I. Zyablova
Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1; Kuban State Medical University
Russian Federation
Russian Federation
Elena I. Zyablova, Dr. Sci. (Med.), Head of the Department of Radiology No. 2; Associate Professor, Head of the Department of Radiology
167 1 Maya St., Krasnodar, 350086
M. V. Vitsenia
National Medical Research Center of Cardiology named after Academician E.I. Chazov, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Marina V. Vitsenia, Cand. Sci. (Med.), Senior Researcher, Department of Outpatient Treatment and Diagnostic Technologies
Moscow
O. V. Stukalova
National Medical Research Center of Cardiology named after Academician E.I. Chazov, Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Olga V. Stukalova, Cand. Sci. (Med.), Leading Researcher, MR Tomography Laboratory
Moscow
References
1. Immune-Related Adverse Events Induced by Immune Checkpoint Inhibitors and CAR-T Cell Therapy / C. Pozzessere [et al.] // A Comprehensive Imaging-Based Review. Cancers (Basel). 2024 Jul 19. № 16(14). Р. 2585. DOI: 10.3390/cancers16142585; PMID: 39061225; PMCID: PMC11274393.
2. Cardiotoxicity of Immune Checkpoint Inhibitors / R.P. Patel [et al.] // Curr. Oncol. Rep. 2021. № 23. Р. 79.
3. Myocarditis in Patients Treated with Immune Checkpoint Inhibitors / S.S. Mahmood [et al.] // J. Am. Coll. Cardiol. 2018. № 71. Р. 1755–1764.
4. Cardiovascular Magnetic Resonance in the Oncology Patient / J.H. Jordan [et al.] // JACC Cardiovasc Imaging. 2018 Aug. № 11(8). Р. 1150–1172. DOI: 10.1016/j.jcmg.2018.06.004; PMID: 30092971; PMCID: PMC6242266.
5. Cardiotoxicity associated with immune checkpoint inhibitor therapy: A meta-analysis / N. Rubio-Infante [et al.] // Eur. J. Heart Fail. 2021. № 23. Р. 1739–1747.
6. Checkpoint inhibitor-induced myocarditis and myasthenia gravis in a recurrent/metastatic thymic carcinoma patient: a case report / C. Szuchan [et al.] // Eur Heart J Case Rep. 2020. № 4. Р. 1–8.
7. PD-1 deficiency results in the development of fatal myocarditis in MRL mice / J. Wang [et al.] // Int Immunol. 2010. № 22. Р. 443–452.
8. Interstitial lung disease induced by fluoxetine: systematic review of literature and analysis of Vigiaccess, Eudravigilance and a national pharmacovigilance database / A. Deidda [et al.] // Pharmacol Res. 2017. № 120. Р. 294–301.
9. Fulminant Myocarditis with Combination Immune Checkpoint Blockade / D.B. Johnson [et al.] // N Engl J Med. 2016. № 375. Р. 1749–1755. DOI: 10.1056/NEJMoa1609214.
10. Reproducibility of echocardiographic techniques for sequential assessment of left ventricular ejection fraction and volumes: application to patients undergoing cancer chemotherapy / P. Thavendiranathan [et al.] // J Am Coll Cardiol. 2013. № 61. Р. 77–84.
11. Role of three-dimensional echocardiography in breast cancer: comparison with two-dimensional echocardiography, multiple-gated acquisition scans, and cardiac magnetic resonance imaging / J. Walker // J Clin Oncol. 2010. № 28. Р. 3429–36.
12. Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy / D. Cardinale [et al.] // Circulation. 2015. № 131. Р. 1981–8.
13. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents / W.G. Hundley [et al.] // J Am Coll Cardiol. 2010. № 55. Р. 2614–62.
14. Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionuclide ventriculography and cardiovascular magnetic resonance. Are they interchangeable? / N. Bellenger [et al.] // Eur Heart J. 2000. № 21. Р. 1387–96.
15. Multi-detector row cardiac computed tomography accurately quantifies right and left ventricular size and function compared with cardiac magnetic resonance / S.V. Raman [et al.] // Am Heart J. 2006. № 151. Р. 736–44.
16. Subclinical cardiotoxic effects of anthracyclines as assessed by magnetic resonance imaging – a pilot study / R. Wassmuth [et al.] // Am Heart J. 2001. № 141. Р. 1007–13.
17. Low to moderate dose anthracycline-based chemotherapy is associated with early noninvasive imaging evidence of subclinical cardiovascular disease / B.C. Drafts [et al.] // J Am Coll Cardiol Img. 2013. № 6. Р. 877–85.
18. Vasu S., Hundley W.G. Understanding cardiovascular injury after treatment for cancer: an overview of current uses and future directions of cardiovascular magnetic resonance // J Cardiovasc Magn Reson. 2013. № 15. Р. 66–83.
19. Vascular and metabolic implications of novel targeted cancer therapies: focus on kinase inhibitors / W. Li [et al.] // J Am Coll Cardiol. 2015. № 66. Р. 1160–78.
20. Spectrum of cardiovascular toxicities of immune checkpoint inhibitors: A pharmacovigilance study / J.-E. Salem [et al.] // Lancet Oncol. 2018. № 19. Р. 1579–1589.
21. Checkpoint inhibitor-induced myocarditis and myasthenia gravis in a recurrent/metastatic thymic carcinoma patient: a case report / C. Szuchan [et al.] // Eur Heart J Case Rep. 2020. № 4. Р. 1–8
22. Determinants of cholesterol and triglycerides recording in patients treated with lipid lowering therapy in UK primary care / A. Maguire [et al.] // Pharmacoepidemiol Drug Saf. 2007. № 16. Р. 228–228.
23. Takotsubo-like syndrome in cancer patients treated with immune checkpoint inhibitors / S. Ederhy [et al.] // JACC Cardiovasc Imaging. 2018. № 11. Р. 1187–1190.
24. The alveolar immune cell landscape is dysregulated in checkpoint inhibitor pneumonitis / K. Suresh [et al.] // J. Clin. Investig. 2019. № 129. Р. 4305–4315.
25. Analysis of cytokines in serum and bronchoalveolar lavage fluid in patients with immune-checkpoint inhibitor-associated pneumonitis: A cross-sectional case–control study / B. Kowalski [et al.] // J. Cancer Res. Clin. Oncol. 2022. № 148. Р. 1711–1720.
26. PubTerm: a web tool for organizing, annotating and curating genes, diseases, molecules and other concepts from PubMed records / J. Garcia-Pelaez [et al.] // Database (Oxford). 2019. № 2019.Р. bay137.
27. Fatal Toxic Effects Associated with Immune Checkpoint Inhibitors / D.Y. Wang [et al.] // JAMA Oncol. 2018. № 4. Р. 1721– 1728.
28. Cardiovascular Magnetic Resonance in Nonischemic Myocardial Inflammation: Expert Recommendations / V.M. Ferreira [et al.] // J. Am. Coll. Cardiol. 2018. № 72. Р. 3158–3176.
29. Cardiac imaging techniques for the assessment of immune checkpoint inhibitor-induced cardiotoxicity and their potential clinical applications / Y. Li [et al.] // Am. J. Cancer Res. 2022. № 12. Р. 3548–3560.
30. Терновой С.К. Томография сердца / С.К. Терновой. М.: ГЭОТАР-Медиа, 2018. 296 с.
31. Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology / H. Mahrholdt [et al.] // Circulation. 2004. № 109. Р. 1250–8.
32. Assessment of myocardial viability by cardiovascular magnetic resonance imaging / H. Mahrholdt // Eur Heart J 2002. № 23. Р. 602–19.
33. Cardiovascular magnetic resonance in myocarditis: a JACC white paper / M.G. Friedrich [et al.] // J Am Coll Cardiol. 2009. № 53. Р. 1475–87.
34. Update on myocarditis / I. Kindermann [et al.] // J Am Coll Cardiol. 2012. № 59. Р. 779–92.
35. Moslehi J.J. Cardiovascular toxic effects of targeted cancer therapies // N Engl J Med. 2016. № 375. Р. 1457–67.
36. Fulminant myocarditis with combination immune checkpoint blockade / D.B. Johnson [et al.] // N Engl J Med. 2016. № 375. Р. 1749–55.
37. Reproducibility of echocardiographic techniques for sequential assessment of left ventricular ejection fraction and volumes: application to patients undergoing cancer chemotherapy / P. Thavendiranathan [et al.] // J Am Coll Cardiol. 2013. № 61. Р. 77–84.
38. Burgdorf C., Kurowski V., Radke P.W. Long-term prognosis of transient left ventricular ballooning syndrome and cancer // Heart Lung. 2011. № 40. Р. 472.
39. Tako-tsubo (stress-induced) cardiomyopathy and cancer / C. Burgdorf [et al.] // Ann Intern Med. 2010. № 152. Р. 830–1.
40. Long-term prognosis of the transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): focus on malignancies / C. Burgdorf // Eur J Heart Fail. 2008. № 10. Р. 1015–9.
41. Cardiac MRI studies of transient left ventricular apical ballooning syndrome (takotsubo cardiomyopathy): a systematic review / G. Leurent [et al.] // Int J Cardiol. 2009. № 135. Р. 146–9.
42. Slowly resolving global myocardial inflammation/oedema in tako-tsubo cardiomyopathy: evidence from T2-weighted cardiac MRI / C. Neil [et al.] // Heart. 2012. № 98. Р. 1278–84.
43. Yusuf S.W., Negi S.I., Lenihan D.J. Infiltrative cardio-myopathy and pericardial disease // Semin Oncol. 2013. № 40. Р. 199–209.
44. Cardiac amyloidosis: MR imaging findings and T1 quantification, comparison with control subjects / G.A. Krombach [et al.] // J Magn Reson Imaging. 2007 Jun. № 25(6). Р. 1283–7. DOI: 10.1002/jmri.20917. PMID: 17520735.
45. Терновой С.К., Путило Д.В., Стукалова О.В., Габрусенко С.А. Структура миокарда у пациентов с гипертрофией левого желудочка различного генеза по данным мрт с отсроченным контрастированием. REJR. 2023; 13 (1):58-69. DOI: 10.21569/2222-7415-2023-13-1-58-69.
46. Intracardiac thrombosis and embolism in patients with cardiac amyloidosis / D. Feng [et al.] // Circulation. 2007. № 116. Р. 2420–6.
47. Roberts W.C., Waller B.F. Cardiac amyloidosis causing cardiac dysfunction: analysis of 54 necropsy patients // Am J Cardiol. 1983. № 52. Р. 137–46.
48. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents / W.G. Hundley [et al.] // J Am Coll Cardiol. 2010. № 55. Р. 2614–62.
49. Cardiovascular T2-star (T2*) magnetic resonance for theearly diagnosis of myocardial iron overload / L. Anderson [et al.] // Eur Heart J. 2001. № 22. Р. 2171–9.
50. Assessment of myocardial fibrosis with cardiovascular magnetic resonance / N. Mewton [et al.] // J Am Coll Cardiol. 2011. № 57. Р. 891–903.
51. Relation of acute pericardial disease to malignancy / M. Imazio [et al.] // Am J Cardiol. 2005. № 95. Р. 1393–4.
52. Maisch B., Ristic A., Pankuweit S. Evaluation and management of pericardial effusion in patients with neoplastic disease // Prog Cardiovasc Dis. 2010. № 53. Р. 157–63.
53. CT and MR imaging of pericardial disease / Z.J. Wang [et al.] // Radiographics. 2003. № 23 Spec. No. Р. S167–80.
54. Pericardial delayed hyperenhancement with CMR imaging in patients with constrictive pericarditis undergoing surgical pericardiectomy: a case series with histopathological correlation / A.O. Zurick [et al.] // JAm Coll Cardiol Img. 2011. № 4. Р. 1180–91.
55. Bogaert J., Francone M. Cardiovascular magnetic resonance in pericardial diseases// J Cardiovasc Magn Reson. 2009. № 11. Р. 14.
56. Use of magnetic resonance imaging in assessment of constrictive pericarditis: a Moroccan center experience / A. Lachhab [et al.] // Int Arch Med 4. 2011. № 36. ГКД Ж https://doi.org/10.1186/1755-7682-4-36
57. Magnetic resonance evaluation of cardiac thrombi and masses by T1 and T2 mapping: an observational study / T. Caspar // Int J Cardiovasc Imaging. 2017. № 33. Р. 551–9.
58. Value of CMR for the differential diagnosis of cardiac masses / P. Pazos-Lopez [et al.] // J Am Coll Cardiol Img. 2014. № 7. Р. 896–905.
59. Cardiovascular magnetic resonance imaging for diagnosis and clinical management of suspected cardiac masses and tumours / S. Fussen [et al.] // Eur Heart J. 2011. № 32. Р. 1551–60.
60. Detection of intracardiac masses in patients with coronary artery disease using cardiac magnetic resonance imaging: a comparison with transthoracic echocardiography / W. Staab [et al.] // Int J Cardiovasc Imaging. 2014. № 30. Р. 647–57.
Review
For citations:
Zyablova E.I., Vitsenia M.V., Stukalova O.V. Radiologic Diagnosis of Cardiac Injury in Patients Undergoing Systemic Anticancer Therapy. Innovative Medicine of Kuban. 2026;11(1-1):42-54. (In Russ.)
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