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123I-MIBG for detection of subacute doxorubicin-induced cardiotoxicity in patients with malignant lymphoma

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Doxorubicin is the mainstay of curative lymphoma treatment but is associated with a dose-dependent cardiotoxicity that is often recognized too late to avoid substantial irreversible cardiac injury. Iodine-123 metaiodobenzylguanidine (123I-MIBG) is a gamma-emitting tracer that mimics noradrenaline uptake, storage, and release mechanisms in adrenergic presynaptic neurons. 123I-MIBG scintigraphy can be used for assessment of doxorubicin-induced injury to myocardial adrenergic neurons during treatment and could be the tool for early detection of doxorubicin cardiotoxicity, which is currently lacking.

Methods and Results

A total of 37 lymphoma patients scheduled for doxorubicin treatment were included in our study. 123I-MIBG imaging was performed prior to chemotherapy and after a median of 4 cycles of doxorubicin. Early and late heart-to-mediastinum ratios (H/Mearly and H/Mlate) and washout rate (WOR) were used for evaluation of cardiotoxicity. The prognostic value of 123I-MIBG results was assessed using left ventricular ejection fraction (LVEF) as measured by cardiac magnetic resonance at 1-year follow-up. We found a post-therapy increase in WOR (including nine patients with > 10% increase), which was not statistically significant (18.6 vs 23.4%, P = 0.09). The difference appeared to be driven by an increase in H/Mearly. LVEF decreased from baseline to 1-year follow-up (64 vs 58%, P = 0.03). LVEF change was not associated with changes in WOR (P = 0.5).

Conclusion

The present study does not provide evidence for 123I-MIBG imaging as a clinically applicable tool for early detection of doxorubicin-induced cardiotoxicity.

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Abbreviations

123I-MIBG:

Iodine-123 metaiodobenzylguanidine

CMR:

Cardiac magnetic resonance

H/M early :

Early heart-to-mediastinum ratio

H/M late :

Late heart-to-mediastinum ratio

LVEF:

Left ventricular ejection fraction

WOR:

Washout rate

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Disclosure

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Authors and Affiliations

  1. Department of Hematology, Rigshospitalet, University of Copenhagen, section 9322, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Adam Høgsbro Laursen MD & Martin Hutchings MD, PhD

  2. Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Department of Biomedical Sciences, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark

    Rasmus Sejersten Ripa MD, DMSc, Philip Hasbak MD, DMSc & Andreas Kjær MD, DMSc

  3. Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    Marie Bayer Elming MD, Lars Køber MD, DMSc & Jens Jakob Thune MD, PhD

  4. Department of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark

    Jens Jakob Thune MD, PhD

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  1. Adam Høgsbro Laursen MD
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Correspondence to Adam Høgsbro Laursen MD.

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Laursen, A.H., Ripa, R.S., Hasbak, P. et al. 123I-MIBG for detection of subacute doxorubicin-induced cardiotoxicity in patients with malignant lymphoma. J. Nucl. Cardiol. 27, 931–939 (2020). https://doi.org/10.1007/s12350-018-01566-y

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  • DOI: https://doi.org/10.1007/s12350-018-01566-y

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