Rubidium-82 positron emission tomography for detection of acute doxorubicin-induced cardiac effects in lymphoma patients
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.
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.
Left ventricular ejection fraction
Myocardial perfusion reserve
Positron emission tomography
Summed rest score
Summed stress score
Summed difference score
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.
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