Skip to main content

Advertisement

Log in

Cardiac Complications of Chemotherapy: Role of Imaging

  • Cardio-oncology (S Francis, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion Statement

New advances in cancer diagnosis and treatment have increased survival rates in patients with cancer. In parallel with this increase in the number of cancer survivors is an increasing prevalence of cardiac complications from cancer treatment. Chemotherapy-induced cardiac dysfunction is a major contributor to adverse morbidity and mortality rates in cancer patients. Evidence suggests that both clinical symptoms and the traditional left ventricular ejection fraction (LVEF) may lack sensitivity as measures of cardiotoxicity. The early identification of subclinical LV dysfunction is becoming increasingly important, as this may allow cancer patients and their physicians to make informed decisions about therapeutic options. The features of echocardiography make it a useful tool in the diagnosis and monitoring of cardiotoxicity. This review will examine the role of cardiac imaging in detecting cardiotoxicity, focusing primarily on the conventional and more recent echocardiographic approaches for assessing subclinical cardiotoxicity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

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

  1. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62(1):10–29.

    Article  PubMed  Google Scholar 

  2. Siegel R, DeSantis C, Virgo K, Stein K, Mariotto A, Smith T, et al. Cancer treatment and survivorship statistics, 2012. CA Cancer J Clin. 2012;62(4):220–41.

    Article  PubMed  Google Scholar 

  3. Jones LW, Haykowsky MJ, Swartz JJ, Douglas PS, Mackey JR. Early breast cancer therapy and cardiovascular injury. J Am Coll Cardiol. 2007;50(15):1435–41.

    Article  PubMed  Google Scholar 

  4. Pinder MC, Duan Z, Goodwin JS, Hortobagyi GN, Giordano SH. Congestive heart failure in older women treated with adjuvant anthracycline chemotherapy for breast cancer. J Clin. 2007;25(25):3808–15.

    Article  CAS  Google Scholar 

  5. Siegel RL, Ward EM, Jemal A. Trends in colorectal cancer incidence rates in the united states by tumor location and stage, 1992–2008. Cancer Epidemiol Biomarkers Prev. 2012;21(3):411–6.

    Article  PubMed  Google Scholar 

  6. Yeh ET, Bickford CL. Cardiovascular complications of cancer therapy: incidence, pathogenesis, diagnosis, and management. J Am Coll Cardiol. 2009;53(24):2231–47.

    Article  CAS  PubMed  Google Scholar 

  7. Force T, Kerkela R. Cardiotoxicity of the new cancer therapeutics–mechanisms of, and approaches to, the problem. Drug Discov Today. 2008;13(17–18):778–84.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Von Hoff DD, Layard MW, Basa P, Davis Jr HL, Von Hoff AL, Rozencweig M, et al. Risk factors for doxorubicin-induced congestive heart failure. Ann Intern Med. 1979;91(5):710–7.

    Article  Google Scholar 

  9. Oeffinger KC, Mertens AC, Sklar CA, Kawashima T, Hudson MM, Meadows AT, et al. Chronic health conditions in adult survivors of childhood cancer. N Engl J Med. 2006;355(15):1572–82.

    Article  CAS  PubMed  Google Scholar 

  10. Doyle JJ, Neugut AI, Jacobson JS, Grann VR, Hershman DL. Chemotherapy and cardiotoxicity in older breast cancer patients: a population-based study. J Clin Oncol. 2005;23(34):8597–605.

    Article  PubMed  Google Scholar 

  11. Lancellotti P, Nkomo VT, Badano LP, Bergler J, Bogaert J, Davin L, et al. Expert consensus for multi-modality imaging evaluation of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr. 2013;26(9):1013–32.

    Article  PubMed  Google Scholar 

  12. Zhang S, Liu X, Bawa-Khalfe T, Lu LS, Lyu YL, Liu LF, et al. Identification of the molecular basis of doxorubicin-induced cardiotoxicity. Nat Med. 2012;18(11):1639–42.

    Article  PubMed  Google Scholar 

  13. Ewer MS, Lippman SM. Type II chemotherapy-related cardiac dysfunction: time to recognize a new entity. J Clin Oncol. 2005;23(13):2900–2.

    Article  CAS  PubMed  Google Scholar 

  14. Lal H, Kolaja KL, Force T. Cancer genetics and the cardiotoxicity of the therapeutics. J Am Coll Cardiol. 2013;61(3):267–74.

    Article  CAS  PubMed  Google Scholar 

  15. Romond EH, Jeong JH, Rastogi P, Swain SM, Geyer CE, Jr., Ewer MS, et al. Seven-year follow-up assessment of cardiac function in NSABP B-31, a randomized trial comparing doxorubicin and cyclophosphamide followed by paclitaxel (ACP) with ACP plus trastuzumab as adjuvant therapy for patients with node-positive, human epidermal growth factor receptor 2-positive breast cancer. J Clin Oncol. 2012;30(31):3792–3799. This study demonstrate the prognostic value of LVEF in predicting chronic cardiotoxicity.

    Google Scholar 

  16. Rickard J, Kumbhani DJ, Baranowski B, Martin DO, Tang WH, Wilkoff BL. Usefulness of cardiac resynchronization therapy in patients with adriamycin-induced cardiomyopathy. Am J Cardiol. 2010;105(4):522–6.

    Article  CAS  PubMed  Google Scholar 

  17. Felker GM, Thompson RE, Hare JM, Hruban RH, Clemetson DE, Howard DL, et al. Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy. N Engl J Med. 2000;342(15):1077–84.

    Article  CAS  PubMed  Google Scholar 

  18. Slamon D, Eiermann W, Robert N, Pienkowski T, Martin M, Press M, et al. Adjuvant trastuzumab in HER2-positive breast cancer. N Engl J Med e. 2011;365(14):1273–1283. This article outlines the pattern of LVEF decrease with anthracycline and trastuzumab therapy.

    Google Scholar 

  19. Cardinale D, Colombo A, Lamantia G, Colombo N, Civelli M, De Giacomi G, et al. Anthracycline–induced cardiomyopathy: clinical relevance and response to pharmacologic therapy. J Am Coll Cardiol. 2010;55(3):213–20.

    Article  CAS  PubMed  Google Scholar 

  20. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, et al. ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society. Circulation. 2005;112(12):e154–235.

    Article  PubMed  Google Scholar 

  21. Bristow MR, Thompson PD, Martin RP, Mason JW, Billingham ME, Harrison DC. Early anthracycline cardiotoxicity. Am J Med. 1978;65(5):823–32.

    Article  CAS  PubMed  Google Scholar 

  22. Oreto L, Todaro MC, Umland MM, Kramer C, Qamar R, Carerj S, et al. Use of echocardiography to evaluate the cardiac effects of therapies used in cancer treatment: what do we know? J Am Soc Echocardiogr. 2012;25(11):1141–52.

    Article  PubMed  Google Scholar 

  23. Ewer MS, Lenihan DJ. Left ventricular ejection fraction and cardiotoxicity: is our ear really to the ground? J Clin Oncol. 2008;26(8):1201–3.

    Article  PubMed  Google Scholar 

  24. Jurcut R, Wildiers H, Ganame J, D'Hooge J, Paridaens R, Voigt JU. Detection and monitoring of cardiotoxicity-what does modern cardiology offer? Support Care Cancer. 2008;16(5):437–45.

    Article  PubMed  Google Scholar 

  25. Jiji RS, Kramer CM, Salerno M. Non-invasive imaging and monitoring cardiotoxicity of cancer therapeutic drugs. J Nucl Cardiol. 2012;19(2):377–88.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Carver JR, Shapiro CL, Ng A, Jacobs L, Schwartz C, Virgo KS, et al. American society of clinical oncology clinical evidence review on the ongoing care of adult cancer survivors: cardiac and pulmonary late effects. J Clin Oncol. 2007;25(25):3991–4008.

    Article  CAS  PubMed  Google Scholar 

  27. Steinherz LJ, Graham T, Hurwitz R, Sondheimer HM, Schwartz RG, Shaffer EM, et al. Guidelines for cardiac monitoring of children during and after anthracycline therapy: Report of the Cardiology Committee of the Childrens Cancer Study Group. Pediatrics. 1992;89(5 Pt 1):942–9.

    CAS  PubMed  Google Scholar 

  28. Friedman MA, Bozdech MJ, Billingham ME, Rider AK. Doxorubicin cardiotoxicity. Serial endomyocardial biopsies and systolic time intervals. JAMA. 1978;240(15):1603–6.

    Article  CAS  PubMed  Google Scholar 

  29. Mason JW, Bristow MR, Billingham ME, Daniels JR. Invasive and noninvasive methods of assessing adriamycin cardiotoxic effects in man: superiority of histopathologic assessment using endomyocardial biopsy. Cancer Treat Rep. 1978;62(6):857–64.

    CAS  PubMed  Google Scholar 

  30. Ewer MS, Ali MK, Mackay B, Wallace S, Valdivieso M, Legha SS, et al. A comparison of cardiac biopsy grades and ejection fraction estimations in patients receiving adriamycin. J Clin Oncol. 1984;2(2):112–7.

    CAS  PubMed  Google Scholar 

  31. Curtis JP, Sokol SI, Wang Y, Rathore SS, Ko DT, Jadbabaie F, et al. The association of left ventricular ejection fraction, mortality, and cause of death in stable outpatients with heart failure. J Am Coll Cardiol. 2003;42(4):736–42.

    Article  PubMed  Google Scholar 

  32. Mitani I, Jain D, Joska TM, Burtness B, Zaret BL. Doxorubicin cardiotoxicity: prevention of congestive heart failure with serial cardiac function monitoring with equilibrium radionuclide angiocardiography in the current era. J Nucl Cardiol. 2003;10(2):132–9.

    Article  PubMed  Google Scholar 

  33. Jensen BV, Skovsgaard T, Nielsen SL. Functional monitoring of anthracycline cardiotoxicity: a prospective, blinded, long-term observational study of outcome in 120 patients. Ann Oncol. 2002;13(5):699–709.

    Article  CAS  PubMed  Google Scholar 

  34. Steinherz LJ, Steinherz PG, Tan CT, Heller G, Murphy ML. Cardiac toxicity 4 to 20 years after completing anthracycline therapy. JAMA. 1991;266(12):1672–7.

    Article  CAS  PubMed  Google Scholar 

  35. Moja L, Tagliabue L, Balduzzi S, Parmelli E, Pistotti V, Guarneri V, et al. Trastuzumab containing regimens for early breast cancer. Cochrane Database Syst Rev. 2012;4:CD006243.

    Google Scholar 

  36. Seidman A, Hudis C, Pierri MK, Shak S, Paton V, Ashby M, et al. Cardiac dysfunction in the trastuzumab clinical trials experience. J Clin Oncol. 2002;20(5):1215–21.

    Article  CAS  PubMed  Google Scholar 

  37. Tan-Chiu E, Yothers G, Romond E, Geyer Jr CE, Ewer M, Keefe D, et al. Assessment of cardiac dysfunction in a randomized trial comparing doxorubicin and cyclophosphamide followed by paclitaxel, with or without trastuzumab as adjuvant therapy in node-positive, human epidermal growth factor receptor 2-overexpressing breast cancer: Nsabp b-31. J Clin Oncol. 2005;23(31):7811–9.

    Article  CAS  PubMed  Google Scholar 

  38. Isner JM, Ferrans VJ, Cohen SR, Witkind BG, Virmani R, Gottdiener JS, et al. Clinical and morphologic cardiac findings after anthracycline chemotherapy. Analysis of 64 patients studied at necropsy. Am J Cardiol. 1983;51(7):1167–74.

    Article  CAS  PubMed  Google Scholar 

  39. Alexander J, Dainiak N, Berger HJ, Goldman L, Johnstone D, Reduto L, et al. Serial assessment of doxorubicin cardiotoxicity with quantitative radionuclide angiocardiography. N Engl J Med. 1979;300(6):278–83.

    Article  CAS  PubMed  Google Scholar 

  40. Nousiainen T, Jantunen E, Vanninen E, Hartikainen J. Early decline in left ventricular ejection fraction predicts doxorubicin cardiotoxicity in lymphoma patients. Br J Cancer. 2002;86(11):1697–700.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  41. Cheng SC, Dy TC, Feinstein SB. Contrast echocardiography: review and future directions. Am J Cardiol. 1998;81(12A):41G–8.

    Article  CAS  PubMed  Google Scholar 

  42. Hoffmann R, von Bardeleben S, ten Cate F, Borges AC, Kasprzak J, Firschke C, et al. Assessment of systolic left ventricular function: a multi-centre comparison of cineventriculography, cardiac magnetic resonance imaging, unenhanced and contrast-enhanced echocardiography. Eur Heart J. 2005;26(6):607–16.

    Article  PubMed  Google Scholar 

  43. Malm S, Frigstad S, Sagberg E, Larsson H, Skjaerpe T. Accurate and reproducible measurement of left ventricular volume and ejection fraction by contrast echocardiography: a comparison with magnetic resonance imaging. J Am Coll Cardiol. 2004;44(5):1030–5.

    Article  PubMed  Google Scholar 

  44. Olszewski R, Timperley J, Szmigielski C, Monaghan M, Nihoyannopoulos P, Senior R, et al. The clinical applications of contrast echocardiography. Eur J. 2007;8(3):S13–23.

    Google Scholar 

  45. Jacobs LD, Salgo IS, Goonewardena S, Weinert L, Coon P, Bardo D, et al. Rapid online quantification of left ventricular volume from real-time three-dimensional echocardiographic data. Eur Heart J. 2006;27(4):460–8.

    Article  PubMed  Google Scholar 

  46. Takuma S, Ota T, Muro T, Hozumi T, Sciacca R, Di Tullio MR, et al. Assessment of left ventricular function by real-time 3-dimensional echocardiography compared with conventional noninvasive methods. J Am Soc Echocardiogr. 2001;14(4):275–84.

    Article  CAS  PubMed  Google Scholar 

  47. Corsi C, Coon P, Goonewardena S, Weinert L, Sugeng L, Polonsky TS, et al. Quantification of regional left ventricular wall motion from real-time 3-dimensional echocardiography in patients with poor acoustic windows: effects of contrast enhancement tested against cardiac magnetic resonance. J Am Soc Echocardiogr. 2006;19(7):886–93.

    Article  PubMed  Google Scholar 

  48. Thavendiranathan P, Grant AD, Negishi T, Plana JC, Popovic ZB, Marwick TH. Reproducibility of echocardiographic techniques for sequential assessment of left ventricular ejection fraction and volumes: application to patients undergoing cancer chemotherapy. J Am Coll Cardiol. 2013;61(1):77–84.

    Article  PubMed  Google Scholar 

  49. Jenkins C, Moir S, Chan J, Rakhit D, Haluska B, Marwick TH. Left ventricular volume measurement with echocardiography: a comparison of left ventricular opacification, three-dimensional echocardiography, or both with magnetic resonance imaging. Eur Heart J. 2009;30(1):98–106.

    Article  PubMed  Google Scholar 

  50. Hare JL, Brown JK, Leano R, Jenkins C, Woodward N, Marwick TH. Use of myocardial deformation imaging to detect preclinical myocardial dysfunction before conventional measures in patients undergoing breast cancer treatment with trastuzumab. Am Heart J. 2009;158(2):294–301.

    Article  CAS  PubMed  Google Scholar 

  51. Moller JE, Pellikka PA, Hillis GS, Oh JK. Prognostic importance of diastolic function and filling pressure in patients with acute myocardial infarction. Circulation. 2006;114(5):438–44.

    Article  PubMed  Google Scholar 

  52. Lee BH, Goodenday LS, Muswick GJ, Yasnoff WA, Leighton RF, Skeel RT. Alterations in left ventricular diastolic function with doxorubicin therapy. J Am Coll Cardiol. 1987;9(1):184–8.

    Article  CAS  PubMed  Google Scholar 

  53. Hausdorf G, Morf G, Beron G, Erttmann R, Winkler K, Landbeck G, et al. Long term doxorubicin cardiotoxicity in childhood: non-invasive evaluation of the contractile state and diastolic filling. Br Heart J. 1988;60(4):309–15.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  54. Marchandise B, Schroeder E, Bosly A, Doyen C, Weynants P, Kremer R, et al. Early detection of doxorubicin cardiotoxicity: interest of Doppler echocardiographic analysis of left ventricular filling dynamics. Am Heart J. 1989;118(1):92–8.

    Article  CAS  PubMed  Google Scholar 

  55. Stoddard MF, Seeger J, Liddell NE, Hadley TJ, Sullivan DM, Kupersmith J. Prolongation of isovolumetric relaxation time as assessed by Doppler echocardiography predicts doxorubicin-induced systolic dysfunction in humans. J Am Coll Cardiol. 1992;20(1):62–9.

    Article  CAS  PubMed  Google Scholar 

  56. Ganz WI, Sridhar KS, Forness TJ. Detection of early anthracycline cardiotoxicity by monitoring the peak filling rate. Am J Clin Oncol. 1993;16(2):109–12.

    Article  CAS  PubMed  Google Scholar 

  57. Cottin Y, Touzery C, Coudert B, Gilles A, Walker P, Massing JL, et al. Impairment of diastolic function during short-term anthracycline chemotherapy. Br Heart J. 1995;73(1):61–4.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  58. Karakurt C, Kocak G, Ozgen U. Evaluation of the left ventricular function with tissue tracking and tissue doppler echocardiography in pediatric malignancy survivors after anthracycline therapy. Echocardiography. 2008;25(8):880–7.

    Article  PubMed  Google Scholar 

  59. Dorup I, Levitt G, Sullivan I, Sorensen K. Prospective longitudinal assessment of late anthracycline cardiotoxicity after childhood cancer: the role of diastolic function. Heart. 2004;90(10):1214–6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  60. Radulescu D, Pripon S, Parv A, Duncea C, Ciuleanu TE. Altered left ventricular diastolic performance in oncologic patients treated with epirubicin. Congestive Heart Failure. 2007;13(4):215–20.

    Article  CAS  PubMed  Google Scholar 

  61. Tassan-Mangina S, Codorean D, Metivier M, Costa B, Himberlin C, Jouannaud C, et al. Tissue Doppler imaging and conventional echocardiography after anthracycline treatment in adults: early and late alterations of left ventricular function during a prospective study. Eur J Echocardiogr. 2006;7(2):141–6.

    Article  PubMed  Google Scholar 

  62. Jones LW, Eves ND, Haykowsky M, Freedland SJ, Mackey JR. Exercise intolerance in cancer and the role of exercise therapy to reverse dysfunction. Lancet Oncol. 2009;10(6):598–605.

    Article  PubMed  Google Scholar 

  63. McKillop JH, Bristow MR, Goris ML, Billingham ME, Bockemuehl K. Sensitivity and specificity of radionuclide ejection fractions in doxorubicin cardiotoxicity. Am Heart J. 1983;106(5 Pt 1):1048–56.

    Article  CAS  PubMed  Google Scholar 

  64. Jarfelt M, Kujacic V, Holmgren D, Bjarnason R, Lannering B. Exercise echocardiography reveals subclinical cardiac dysfunction in young adult survivors of childhood acute lymphoblastic leukemia. Pediatr Blood Cancer. 2007;49(6):835–40.

    Article  CAS  PubMed  Google Scholar 

  65. Civelli M, Cardinale D, Martinoni A, Lamantia G, Colombo N, Colombo A, et al. Early reduction in left ventricular contractile reserve detected by dobutamine stress echo predicts high-dose chemotherapy-induced cardiac toxicity. Int J Cardiol. 2006;111(1):120–6.

    Article  PubMed  Google Scholar 

  66. Hamada H, Ohkubo T, Maeda M, Ogawa S. Evaluation of cardiac reserved function by high-dose dobutamine-stress echocardiography in asymptomatic anthracycline-treated survivors of childhood cancer. Pediatr Int. 2006;48(3):313–20.

    Article  CAS  PubMed  Google Scholar 

  67. Bountioukos M, Doorduijn JK, Roelandt JR, Vourvouri EC, Bax JJ, Schinkel AF, et al. Repetitive dobutamine stress echocardiography for the prediction of anthracycline cardiotoxicity. Eur J Echocardiogr. 2003;4(4):300–5.

    Article  CAS  PubMed  Google Scholar 

  68. Lanzarini L, Bossi G, Laudisa ML, Klersy C, Arico M. Lack of clinically significant cardiac dysfunction during intermediate dobutamine doses in long-term childhood cancer survivors exposed to anthracyclines. Am Heart J. 2000;140(2):315–23.

    Article  CAS  PubMed  Google Scholar 

  69. D'Hooge J, Heimdal A, Jamal F, Kukulski T, Bijnens B, Rademakers F, et al. Regional strain and strain rate measurements by cardiac ultrasound: principles, implementation and limitations. Eur J Echocardiogr. 2000;1(3):154–70.

    Article  PubMed  Google Scholar 

  70. Kowalski M, Kukulski T, Jamal F, D'Hooge J, Weidemann F, Rademakers F, et al. Can natural strain and strain rate quantify regional myocardial deformation? A study in healthy subjects. Ultrasound Med Biol. 2001;27(8):1087–97.

    Article  CAS  PubMed  Google Scholar 

  71. Urheim S, Edvardsen T, Torp H, Angelsen B, Smiseth OA. Myocardial strain by Doppler echocardiography. Validation of a new method to quantify regional myocardial function. Circulation. 2000;102(10):1158–64.

    Article  CAS  PubMed  Google Scholar 

  72. Voigt JU, Arnold MF, Karlsson M, Hubbert L, Kukulski T, Hatle L, et al. Assessment of regional longitudinal myocardial strain rate derived from Doppler myocardial imaging indexes in normal and infarcted myocardium. J Am Soc Echocardiogr. 2000;13(6):588–98.

    Article  CAS  PubMed  Google Scholar 

  73. Ganame J, Claus P, Uyttebroeck A, Renard M, D'Hooge J, Bijnens B, et al. Myocardial dysfunction late after low-dose anthracycline treatment in asymptomatic pediatric patients. J Am Soc Echocardiogr. 2007;20(12):1351–8.

    Article  PubMed  Google Scholar 

  74. Jurcut R, Wildiers H, Ganame J, D'Hooge J, De Backer J, Denys H, et al. Strain rate imaging detects early cardiac effects of pegylated liposomal doxorubicin as adjuvant therapy in elderly patients with breast cancer. J Am Soc Echocardiogr. 2008;21(12):1283–9.

    Article  PubMed  Google Scholar 

  75. Sawaya H, Sebag IA, Plana JC, Januzzi JL, Ky B, Cohen V, et al. Early detection and prediction of cardiotoxicity in chemotherapy-treated patients. Am J Cardiol. 2011;107(9):1375–1380. This is the largest study to date that demonstrates the prognostic value of strain in predicting chronic cardiotoxicity.

    Google Scholar 

  76. Motoki H, Koyama J, Nakazawa H, Aizawa K, Kasai H, Izawa A, et al. Torsion analysis in the early detection of anthracycline-mediated cardiomyopathy. Eur Heart J Cardiovasc Imaging. 2012;13(1):95–103.

    Article  PubMed  Google Scholar 

  77. Neilan TG, Jassal DS, Perez-Sanz TM, Raher MJ, Pradhan AD, Buys ES, et al. Tissue Doppler imaging predicts left ventricular dysfunction and mortality in a murine model of cardiac injury. Eur Heart J. 2006;27(15):1868–75.

    Article  PubMed  Google Scholar 

  78. Sawaya H, Sebag IA, Plana JC, Januzzi JL, Ky B, Tan TC, et al. Assessment of echocardiography and biomarkers for the extended prediction of cardiotoxicity in patients treated with anthracyclines, taxanes and trastuzumab. Circ Cardiovasc Imaging. 2012;5(5):596–603.

    Google Scholar 

  79. Negishi K, Negishi T, Hare JL, Haluska BA, Plana JC, Marwick TH. Independent and incremental value of deformation indices for prediction of trastuzumab-induced cardiotoxicity. J Am Soc Echocardiogr. 2013;26(5):493–8.

    Article  PubMed  Google Scholar 

  80. Fallah-Rad N, Walker JR, Wassef A, Lytwyn M, Bohonis S, Fang T, et al. The utility of cardiac biomarkers, tissue velocity and strain imaging, and cardiac magnetic resonance imaging in predicting early left ventricular dysfunction in patients with human epidermal growth factor receptor II-positive breast cancer treated with adjuvant trastuzumab therapy. J Am Coll Cardiol. 2011;57(22):2263–70.

    Article  CAS  PubMed  Google Scholar 

  81. Poterucha JT, Kutty S, Lindquist RK, Li L, Eidem BW. Changes in left ventricular longitudinal strain with anthracycline chemotherapy in adolescents precede subsequent decreased left ventricular ejection fraction. J Am Soc Echocardiogr. 2012;25(7):733–40.

    Article  PubMed  Google Scholar 

  82. Stoodley PW, Richards DA, Hui R, Boyd A, Harnett PR, Meikle SR, et al. Two-dimensional myocardial strain imaging detects changes in left ventricular systolic function immediately after anthracycline chemotherapy. Eur J Echocardiogr. 2011;12(12):945–52.

    Article  PubMed  Google Scholar 

  83. Schwartz RG, McKenzie WB, Alexander J, Sager P, D'Souza A, Manatunga A, et al. Congestive heart failure and left ventricular dysfunction complicating doxorubicin therapy. Seven-year experience using serial radionuclide angiocardiography. Am J Med. 1987;82(6):1109–18.

    Article  CAS  PubMed  Google Scholar 

  84. Ritchie JL, Singer JW, Thorning D, Sorensen SG, Hamilton GW. Anthracycline cardiotoxicity: clinical and pathologic outcomes assessed by radionuclide ejection fraction. Cancer. 1980;46(5):1109–16.

    Article  CAS  PubMed  Google Scholar 

  85. van Royen N, Jaffe CC, Krumholz HM, Johnson KM, Lynch PJ, Natale D, et al. Comparison and reproducibility of visual echocardiographic and quantitative radionuclide left ventricular ejection fractions. Am J Cardiol. 1996;77(10):843–50.

    Article  PubMed  Google Scholar 

  86. Bird BR, Swain SM. Cardiac toxicity in breast cancer survivors: review of potential cardiac problems. Clin Cancer Res. 2008;14(1):14–24.

    Article  CAS  PubMed  Google Scholar 

  87. Cranney GB, Lotan CS, Dean L, Baxley W, Bouchard A, Pohost GM. Left ventricular volume measurement using cardiac axis nuclear magnetic resonance imaging. Validation by calibrated ventricular angiography. Circulation. 1990;82(1):154–63.

    Article  CAS  PubMed  Google Scholar 

  88. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR. 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology. J Am Coll Radiol. 2006;3(10):751–71.

    Article  Google Scholar 

  89. Wassmuth R, Lentzsch S, Erdbruegger U, Schulz-Menger J, Doerken B, Dietz R, et al. Subclinical cardiotoxic effects of anthracyclines as assessed by magnetic resonance imaging-a pilot study. Am Heart J. 2001;141(6):1007–13.

    Article  CAS  PubMed  Google Scholar 

  90. Tham E, Chow K, Spavor M, Pagano J, Haykowsky M, Thompson PD. Degree of diffuse fibrosis measured by MRI correlates with LV remodelling in childhood cancer survivors after anthracycline chemotherapy. J Cardiovasc Magn Reson. 2011;13 Suppl 1:276.

    Article  Google Scholar 

  91. Neilan TG, Coelho-Filho OR, Shah RV, Feng JH, Pena-Herrera D, Mandry D, et al. Myocardial extracellular volume by cardiac magnetic resonance imaging in patients treated with anthracycline-based chemotherapy. Am J Cardiol. 2013;111(5):717–22.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  92. Drafts BC, Twomley KM, D'Agostino Jr R, Lawrence J, Avis N, Ellis LR, et al. Low to moderate dose anthracycline-based chemotherapy is associated with early noninvasive imaging evidence of subclinical cardiovascular disease. JACC Cardiovasc Imaging. 2013;6(8):877–85.

    Article  PubMed  Google Scholar 

  93. Iles L, Pfluger H, Phrommintikul A, Cherayath J, Aksit P, Gupta SN, et al. Evaluation of diffuse myocardial fibrosis in heart failure with cardiac magnetic resonance contrast-enhanced T1 mapping. J Am Coll Cardiol. 2008;52(19):1574–80.

    Article  PubMed  Google Scholar 

  94. Ugander M, Oki AJ, Hsu LY, Kellman P, Greiser A, Aletras AH, et al. Extracellular volume imaging by magnetic resonance imaging provides insights into overt and sub-clinical myocardial pathology. Eur Heart J. 2012;33(10):1268–78.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  95. Hundley WG, Kizilbash AM, Afridi I, Franco F, Peshock RM, Grayburn PA. Administration of an intravenous perfluorocarbon contrast agent improves echocardiographic determination of left ventricular volumes and ejection fraction: comparison with cine magnetic resonance imaging. J Am Coll Cardiol. 1998;32(5):1426–32.

    Article  CAS  PubMed  Google Scholar 

  96. Ganame J, Claus P, Eyskens B, Uyttebroeck A, Renard M, D'Hooge J, et al. Acute cardiac functional and morphological changes after anthracycline infusions in children. Am J Cardiol. 2007;99(7):974–7.

    Article  CAS  PubMed  Google Scholar 

  97. Jurcut R, Pappas CJ, Masci PG, Herbots L, Szulik M, Bogaert J, et al. Detection of regional myocardial dysfunction in patients with acute myocardial infarction using velocity vector imaging. J Am Soc Echocardiogr. 2008;21(8):879–86.

    Article  PubMed  Google Scholar 

  98. Cadeddu C, Piras A, Mantovani G, Deidda M, Dessi M, Madeddu C, et al. Protective effects of the angiotensin II receptor blocker telmisartan on epirubicin-induced inflammation, oxidative stress, and early ventricular impairment. Am Jeart J. 2010;160(3):e481–7.

    Google Scholar 

  99. Stoodley PW, Richards DA, Meikle SR, Clarke J, Hui R, Thomas L. The potential role of echocardiographic strain imaging for evaluating cardiotoxicity due to cancer therapy. Heart Lung Circ. 2011;20(1):3–9.

    Article  PubMed  Google Scholar 

  100. Cheung YF, Hong WJ, Chan GC, Wong SJ, Ha SY. Left ventricular myocardial deformation and mechanical dyssynchrony in children with normal ventricular shortening fraction after anthracycline therapy. Heart. 2010;96(14):1137–41.

    Article  PubMed  Google Scholar 

  101. Tsai HR, Gjesdal O, Wethal T, Haugaa KH, Fossa A, Fossa SD, et al. Left ventricular function assessed by two-dimensional speckle tracking echocardiography in long-term survivors of Hodgkin's lymphoma treated by mediastinal radiotherapy with or without anthracycline therapy. Am J Cardiol. 2011;107(3):472–7.

    Article  PubMed  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Dr. Timothy C. Tan is supported by an American Society of Echocardiography Career Development Award and the Robert and Elizabeth Albert Study Grant (Royal Australasian College of Physicians).

Dr. Marielle Scherrer-Crosbie is supported by an investigator-initiated grant from Susan G. Komen for the Cure Foundation, the Claflin Distinguished Scholar Award, and a Clinical Innovation Award from MGH.

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.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Marielle Scherrer-Crosbie MD, PhD.

Additional information

This article is part of the Topical Collection on Cardio-oncology

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tan, T.C., Scherrer-Crosbie, M. Cardiac Complications of Chemotherapy: Role of Imaging. Curr Treat Options Cardio Med 16, 296 (2014). https://doi.org/10.1007/s11936-014-0296-3

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11936-014-0296-3

Keywords

Navigation