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Role of Imaging in Cardio-Oncology

  • Erick Avelar
  • Caitlin R. Strickland
  • Guido Rosito
Imaging (Q Truong, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Imaging

Opinion statement

Recent advances in cancer treatment and research have greatly improved survival rates for patients with cancer. However, many of these cancer survivors are developing cardiac disease—most commonly heart failure as a result of this treatment. Certain chemotherapeutic agents, including anthracyclines and trastuzumab, have been linked to cardiotoxicity-induced cardiomyopathy in cancer patients. It has been reported as early as during infusion and as late as several years following treatment. Radiation therapy, particularly to the left breast, has also been linked to cardiac disease. The responsibility of cardiac monitoring has traditionally fallen on oncologists using assessment of LVEF through multigated acquisition (MUGA) scans or echocardiograms. The “formal” definition of cardiotoxicity, as a 5 to 10% decrease in LVEF from its baseline, even though not validated, is currently used by clinicians to alter treatment, but it has been recently challenged, as a possible irreversible late stage of a myocardial insult. Furthermore, it falls into the interobserver variability range of echocardiography. The growing field of medicine called cardio-oncology is based on emerging research that has shown that more advanced imaging modalities can help detect cardiotoxicity early, allowing the patient to receive treatment and avoid developing heart failure from cancer treatment. While traditional imaging still has its place in cardiac monitoring, cardiac magnetic resonance imaging is the most accurate and detailed imaging modality available to assess cardiotoxicity. Our own pilot cardiac MRI study suggests that a normal left ventricular remodeling to chemotherapy, when patients have not developed heart failure symptoms, could occur over time. Perhaps, knowing a baseline normal response could help us to define a more accurate definition of cardiotoxicity by CMR. Here, we discuss various imaging modalities and emerging techniques that can assist in detecting early signs of cardiotoxicity and thus reduce the incidence of cardiac disease in cancer survivors.

Keywords

Cardiotoxicity Echocardiography Cardiac MRI Cardiac imaging-chemotherapy Cancer treatment Cancer Cardiomyopathy 

Notes

Compliance with Ethical Standards

Conflict of Interest

Erick Avelar, Caitlin R. Strickland, and Guido Rosito each declare no potential conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Erick Avelar
    • 1
  • Caitlin R. Strickland
    • 2
  • Guido Rosito
    • 3
  1. 1.Division of Cardiology, Oconee Heart and Vascular CenterAugusta University/University of Georgia Medical PartnershipAthensUSA
  2. 2.Oconee Heart and Vascular CenterAthensUSA
  3. 3.Division of CardiologyUFCSPA (Universidade Federal de Ciências da Saúde de Porto Alegre)POABrazil

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