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Rubidium-82 positron emission tomography for detection of acute doxorubicin-induced cardiac effects in lymphoma patients

  • Adam Høgsbro Laursen
  • Marie Bayer Elming
  • Rasmus Sejersten Ripa
  • Philip Hasbak
  • Andreas Kjær
  • Lars Køber
  • Jacob Louis Marott
  • Jens Jakob Thune
  • Martin Hutchings
Original Article

Abstract

Background

Doxorubicin is a cornerstone in lymphoma treatment, but is limited by dose-dependent cardiotoxicity. Rubidium-82 positron emission tomography (82Rb PET) assesses coronary microvascular function through absolute quantification of myocardial perfusion and myocardial perfusion reserve (MPR). Doxorubicin-induced microvascular injury represents a potential early marker of cardiotoxicity.

Methods and results

We included 70 lymphoma patients scheduled for doxorubicin-based treatment. Cardiotoxicity was evaluated with 82Rb PET myocardial perfusion imaging during rest and adenosine stress before chemotherapy and shortly after the first doxorubicin exposure. Patients with a MPR decline > 20% were defined as having a low threshold for cardiotoxicity. In the 54 patients with complete data sets, MPR was significantly lower after the initial doxorubicin exposure (2.69 vs 2.51, P = .03). We registered a non-significant decline in stress perfusion (3.18 vs 3.02 ml/g/min, P = .08), but no change in resting myocardial perfusion. There were 13 patients with a low cardiotoxic threshold. These patients had a significantly higher age, but were otherwise similar to the remaining part of the study population.

Conclusion

Decreases in MPR after initial doxorubicin exposure in lymphoma patients may represent an early marker of doxorubicin-induced cardiotoxicity. The prognostic value of acute doxorubicin-induced changes in MPR remains to be investigated.

Abbreviations

HF

Heart failure

LVEF

Left ventricular ejection fraction

MPR

Myocardial perfusion reserve

PET

Positron emission tomography

Rb

Rubidium

SRS

Summed rest score

SSS

Summed stress score

SDS

Summed difference score

Notes

Acknowledgements

The authors would like to gratefully acknowledge the following research funds for their financial support: The Danish Cancer Society; Rigshospitalet Research Fund; Brødrene Hartmanns Fond; Eva og Henry Frænkels Mindefond; Dagmar Marshalls Fond; KV Fonden; Fabrikant Einar Willumsens Mindelegat; LM Byg; and lastly the research funds of the Department of Cardiology and the Department of Haematology, Rigshospitalet. Furthermore, we sincerely thank all the patients who agreed to participate in our study.

Disclosure

None.

Supplementary material

12350_2018_1458_MOESM1_ESM.docx (19 kb)
Supplementary material 1 (DOCX 18 kb)
12350_2018_1458_MOESM2_ESM.pptx (506 kb)
Supplementary material 2 (PPTX 506 kb)

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Copyright information

© American Society of Nuclear Cardiology 2018

Authors and Affiliations

  • Adam Høgsbro Laursen
    • 1
  • Marie Bayer Elming
    • 2
  • Rasmus Sejersten Ripa
    • 3
  • Philip Hasbak
    • 3
  • Andreas Kjær
    • 3
  • Lars Køber
    • 2
  • Jacob Louis Marott
    • 4
  • Jens Jakob Thune
    • 2
    • 5
    • 6
  • Martin Hutchings
    • 1
  1. 1.Department of Hematology, RigshospitaletUniversity of CopenhagenCopenhagen ØDenmark
  2. 2.Department of Cardiology, RigshospitaletUniversity of CopenhagenCopenhagen ØDenmark
  3. 3.Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Department of Biomedical Sciences, RigshospitaletUniversity of CopenhagenCopenhagen ØDenmark
  4. 4.Copenhagen City Heart Study, Bispebjerg and Frederiksberg HospitalUniversity of CopenhagenFrederiksbergDenmark
  5. 5.Department of Cardiology, Bispebjerg and Frederiksberg HospitalUniversity of CopenhagenFrederiksbergDenmark
  6. 6.Department of Cardiology, Bispebjerg and Frederiksberg HospitalUniversity of CopenhagenCopenhagen NVDenmark

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