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

Journal of Nuclear Cardiology volume 27, pages 1698–1707 (2020)Cite this 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.

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Figure 1
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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

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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.

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Author information

Affiliations

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

    Adam Høgsbro Laursen MD & Martin Hutchings MD, PhD

  2. Department of Cardiology, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark

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

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

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

  4. Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark

    Jacob Louis Marott MSc

  5. Department of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark

    Jens Jakob Thune MD, PhD

  6. Department of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark

    Jens Jakob Thune MD, PhD

Authors
  1. Adam Høgsbro Laursen MD
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  2. Marie Bayer Elming MD
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  5. Andreas Kjær MD, DMSc
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  6. Lars Køber MD, DMSc
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  7. Jacob Louis Marott MSc
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Correspondence to Adam Høgsbro Laursen MD.

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Laursen, A.H., Elming, M.B., Ripa, R.S. et al. Rubidium-82 positron emission tomography for detection of acute doxorubicin-induced cardiac effects in lymphoma patients. J. Nucl. Cardiol. 27, 1698–1707 (2020). https://doi.org/10.1007/s12350-018-1458-6

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  • DOI: https://doi.org/10.1007/s12350-018-1458-6