Chemotherapy – ABC CARDIOL

ABCIC

Original Article

Monitoring Myocardial Metabolic Changes in Lymphoma Patients Undergoing Chemotherapy Using FDG PET/CT

Diego Rafael Freitas Berenguer et al. Gustavo Freitas Alves de Arruda Monica de Moraes Chaves Becker Mayara Lais Coelho Dourado … Roberto de Oliveira Buril Felipe Alves Mourato Paulo José de Almeida Filho Brivaldo Markman-Filho Simone Cristina Soares Brandão

Abstract

Background:

Cardiotoxicity is a serious adverse effect of chemotherapy, often identified only after irreversible myocardial damage has occurred. Positron emission tomography/computed tomography (PET/CT) using fluorine-18 fluorodeoxyglucose (¹⁸F-FDG) allows for the evaluation of myocardial glucose metabolism and may help detect early metabolic changes related to chemotherapy.

Objective:

To assess changes in ¹⁸F-FDG standardized uptake values (SUVs) across different cardiac regions before and after chemotherapy in patients with lymphoma, and to identify which region exhibits the greatest increase.

Methods:

This retrospective cohort study included 62 lymphoma patients who underwent ¹⁸F-FDG PET/CT before and after chemotherapy. SUV measurements were obtained in the left ventricular (LV) free wall, interventricular septum (IVS), right ventricular (RV) free wall, and global myocardium. Control regions included the liver and aorta. Pre- and post-treatment SUV values were compared to evaluate metabolic changes related to chemotherapy.

Results:

Myocardial ¹⁸F-FDG uptake increased significantly after chemotherapy across all cardiac regions, with the most pronounced rise observed in the LV free wall (maximum SUV increase of 73%, p<0.001). The RV free wall showed a non-significant increase in SUV, and no significant changes were observed in the liver or aorta.

Conclusions:

Chemotherapy was associated with a global increase in myocardial ¹⁸F-FDG uptake, with the most pronounced elevation observed in the LV free wall. This regional predominance highlights the LV free wall as the most sensitive site for detecting early metabolic changes potentially related to cardiotoxicity.

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ABCIC

Original Article

Global Longitudinal Strain as Predictor of Chemotherapy-Induced Cardiotoxicity

Monica Samuel Avila et al. Marco Stephan Lofrano Alves Silvia Moreira Ayub-Ferreira Mauro Rogerio de Barros Wanderley Junior … Fatima das Dores Cruz Sara Michelly Gonçalves Brandão Ludhmila Abrahão Hajjar Roberto Kalil Filho Cecilia Beatriz Bittencourt Viana Cruz Maria Cristina Abduch Danilo Bora Moleta Edimar Alcides Bocchi

Abstract

Background

Chemotherapy-induced cardiotoxicity (ChC) is an important complication among patients receiving anthracyclines. Biomarkers and imaging parameters have been studied for their ability to identify patients at risk of developing ChC. Left ventricular global longitudinal strain (LV-GLS) is a sensitive parameter for detecting systolic dysfunction despite the presence of preserved left ventricular ejection fraction (LVEF).

Objective

To evaluate the role of the LV-GLS as a predictor of ChC.

Methods

This was a post-hoc analysis of the Carvedilol for Prevention of Chemotherapy-Related Cardiotoxicity trial, which evaluated the primary prevention of cardiotoxicity with carvedilol during doxorubicin chemotherapy in a population of patients with breast cancer. Cardiotoxicity was defined as a reduction ≥10% in LVEF. LV-GLS was determined before chemotherapy in patients with no prior cardiovascular disease or echocardiogram abnormalities.

Results

Thirty-one patients for whom a complete echocardiography study including measurement of LV-GLS was performed before chemotherapy were included in this analysis. An absolute LV-GLS<16.9% before chemotherapy showed 100% sensitivity and 73% specificity for predicting cardiotoxicity (area under the curve [AUC], 0.85; 95% confidence interval [CI], 0.680–0.959; p<0.001). In this population, LVEF values before chemotherapy did not predict ChC (95% CI, 0.478 to -0.842; p=0.17). The association of low LV-GLS (17 pg/mL) at 2 months after chemotherapy increased the accuracy for detecting early-onset ChC (100% sensitivity, 88% specificity; AUC, 0.94; 95% CI, 0.781–0.995; p<0.0001).

Conclusions

Our data suggest that LV-GLS is a potential predictor of ChC. Larger studies are needed to confirm its clinical relevance in this clinical setting.

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ABCHF

Review Article

Heart Failure with Preserved Ejection Fraction and Cancer

Antonio José Lagoeiro Jorge et al. Humberto Villacorta Luiz Claudio Danzmann Evandro Tinoco Mesquita

Abstract

Heart failure with preserved ejection fraction (HFpEF) is associated with high morbidity and mortality. After hospitalization for heart failure, the 5-year survival of HFpEF is 35%, which is worse than many forms of cancer. HFpEF and cancer share common risk factors. The use of chemotherapy medications such as anthracyclines is associated with increased aortic stiffness and diastolic dysfunction, suggesting that anthracycline therapy may increase the risk of HFpEF, given that worsening of diastolic function, which can be associated with the occurrence of HFpEF, is an early sign of cardiotoxicity. Radiotherapy, widely used in the treatment of breast cancer, leads to an increased risk of developing heart disease since radiation induces coronary microvascular endothelial damage and inflammation, leading to microvascular rarefaction, myocardial inflammation, oxidative stress, and fibrosis, which favor the development of HFpEF. Early diagnosis of cardiotoxicity is an important issue in the care of patients with cancer, and biomarkers have been extensively studied in predicting systolic dysfunction and heart failure with reduced ejection fraction, as well as in the development of HFpEF. HFpEF and cancer have an elevated prevalence, and they share age group, risk factors, and the pathophysiological phenomenon, in which inflammation plays a preponderant role. Biomarkers, especially natriuretic peptides, and ultrasound imaging are fundamental tools in the diagnostic detection and follow-up of these patients.

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ABC

Original Article

Chemotherapy-induced Cardiac18F-FDG Uptake in Patients with Lymphoma: An Early Metabolic Index of Cardiotoxicity?

Mayara L. C. Dourado et al. Luca T. Dompieri Glauber M. Leitão Felipe A. Mourato … Renata G. G. Santos Paulo J Almeida Filho Brivaldo Markman Filho Marcelo D. T. Melo Simone C. S. Brandão

Abstract

Background

It is uncertain whether myocardial fluorodeoxyglucose uptake occurs solely due to physiological features or if it represents a metabolic disarrangement under chemotherapy.

Objective

To investigate the chemotherapy effects on the heart of patients with lymphoma by positron emission tomography associated with computed tomography scans (PET/CT) with 2-deoxy-2[18F] fluoro-D-glucose (¹⁸F-FDG PET/CT) before, during and/or after chemotherapy.

Methods

Seventy patients with lymphoma submitted to¹⁸F-FDG PET/CT were retrospectively analyzed. The level of significance was 5%.¹⁸F-FDG cardiac uptake was assessed by three measurements: left ventricular maximum standardized uptake value (SUVmax), heart to blood pool (aorta) ratio, and heart to liver ratio in all the exams. Body weight, fasting blood sugar, post-injection time, and the injected dose of¹⁸F-FDG between the scans were also compared.

Results

Mean age was 50.4 ± 20.1 years and 50% was female. The analysis was carried out in two groups: baseline vs. interim PET/CT, and baseline vs. post-therapy PET/CT. There was no significant difference in clinical variables or protocol scans variables. We observed an increase in left ventricular (LV) SUVmax from 3.5±1.9 (baseline) to 5.6±4.0 (interim), p=0.01, and from 4.0±2.2 (baseline) to 6.1±4.2 (post-therapy), p<0.001. A percentage increase ≥30% of LV SUVmax occurred in more than half of the sample. The rise of cardiac SUV was accompanied by an increase in LV SUVmax/Aorta SUVmax and LV SUVmean/Liver SUVmean ratios.

Conclusion

This study showed a clear increase in cardiac¹⁸F-FDG uptake in patients with lymphoma during and/or after chemotherapy. The literature corroborates with these findings and suggests that¹⁸F-FDG PET/CT is a sensitive and reliable imaging exam to detect early metabolic signs of cardiotoxicity.

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Monitoring Myocardial Metabolic Changes in Lymphoma Patients Undergoing Chemotherapy Using FDG PET/CT

Abstract

Background:

Objective:

Methods:

Results:

Conclusions:

Global Longitudinal Strain as Predictor of Chemotherapy-Induced Cardiotoxicity

Abstract

Background

Objective

Methods

Results

Conclusions

Heart Failure with Preserved Ejection Fraction and Cancer

Abstract

Chemotherapy-induced Cardiac18F-FDG Uptake in Patients with Lymphoma: An Early Metabolic Index of Cardiotoxicity?

Abstract

Background

Objective

Methods

Results

Conclusion

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