Nuclear Oncology pp 1483-1510 | Cite as

Imaging the Heart in the Cancer Patient

Reference work entry
First Online:

Abstract

The average age of a cancer patient is 67. Sexagenarians with cancer are likely to have comorbidities at the time of diagnosis. Cancer patients > 55 years old have an average of ~2.9 comorbidities, while cancer patients older than 75 have an average of 4.2 comorbidities.

The likelihood of coronary artery disease as an etiology of this comorbidity increases with the age of the patient. Cardiovascular comorbidity is present in ~20% of patients with neoplasm. These comorbidities increase the risk of a serious cardiovascular event during treatment. An additional risk factor is limited work capacity. If patients cannot perform 4 metabolic equivalents of work, their all cause mortality is increased. Patients with cancer and known cardiovascular comorbidity or risk factors such as diabetes, hypertension, smoking history, or limited work capacity should have medical clearance prior to invasive diagnostic procedures, major surgery, mediastinal radiation, and/or potentially cardiotoxic chemotherapy.

Medical clearance should include a detailed cardiovascular history and physical examination. This information will permit calculation of a clinical score to define the risk of adverse events as a result of a major surgical procedure, blood tests to determine hematologic and renal status, and if necessary, assessment of the patients work capacity. Stress testing with imaging should be done in patients with an intermediate risk of coronary heart disease and considered in patients with limited work capacity or advanced age. In selected patients, coronary CT angiography or coronary calcium score may be a suitable evaluation. In patients with cancer of the esophagus, breast, lung, melanoma, or lymphoma, chest-CT and PET/CT studies should be carefully evaluated to detect possible pericardial or myocardial involvement.

Chemotherapy may cause myocardial ischemia due to coronary spasm and decreased ventricular function due to irreversible or reversible myocardial damage, as well as repolarization abnormalities, which may result in fatal arrhythmia. Radiotherapy may accelerate the development of atherosclerosis of vessels in the radiation field and cause irreversible damage to myocardium in the radiation field. Myocardial perfusion imaging is useful to detect regions of acute ischemia or scar induced by therapy, while blood pool imaging is useful for serial monitoring of ventricular function.

Keywords

Heart imaging in the cancer patient Cardiovascular comorbidities in the cancer patient Cardiotoxic chemotherapy Stress testing in cancer patients Heart disease in cancer patients Cancer coexisting with cardiovascular disease 

Glossary

[18F]FDG

2-deoxy-2-[18F]fluoro-D-glucose

ACC

American College of cardiology

ACE

Angiotensin-converting enzyme

AHA

American Heart Association

AL

light chain amyloid

AMI

Acute myocardial infarction

ASCO

American Society of Clinical Oncology

ATTR

transthyretin amyloid

ATP

Adenosine triphosphate

BNP

B-type natriuretic peptide

CAD

coronary artery disease

CHF

Congestive heart failure

CI

confidence interval

C-MRI

Cardiac magnetic resonance imaging

COPD

chronic obstructive pulmonary disease

CRCD

Chemotherapy-related cardiac dysfunction

CRP

C-reactive protein

CT

X-ray computed tomography

CTCAE

Common terminology criteria for adverse events

DTPA

diethylenetriaminepentaacetic acid

DVT/PE

Deep venous thrombosis/pulmonary embolism

EDTA

ethylenediaminetetraacetic acid

ErbB2

a member of the tyrosine-protein kinase family (also known as CD340)

HER2

Human epidermal growth factor receptor 2

HR

hazard ratio

HTN

Hypertension

LEVF

Left ventricular ejection fraction

LGE

Late gadolinium enhancement

LHIS

Lipomatous hypertrophy of the interatrial septum

LV

left ventricle

METS

Metabolic equivalents

MI

myocardial infarction

MIP

maximum intensity projection

MPI

Myocardial perfusion imaging

MRI

Magnetic resonance imaging

MSKCC

Memorial Sloan-Kettering Cancer Center

MUGA

Multigated acquisition

NCI

National Cancer Institute, National Institutes of Health of the United States

PET

positron emission tomography

PET/CT

positron emission tomography/computed tomography

P-POSSUM

Predicted mortality-physiologic and operative severity score

RCRI

Revised cardiovascular risk index

RCRS

Revised cardiac risk score

RVG

Radionuclide ventriculography

SEER

Surveillance, Epidemiology, and End Results

SPECT

single-photon emission computed tomography

SUV

standardized uptake value

TEE

transesophageal echocardiography

VEGF

vascular endothelial growth factor

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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Department of RadiologyMemorial Sloan Kettering Cancer CenterNew YorkUSA
  2. 2.Molecular Imaging and Therapy ServiceMemorial Sloan Kettering Cancer CenterNew YorkUSA

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