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Cadour F, Thuny F, Sourdon J. New Insights in Early Detection of Anticancer Drug-Related Cardiotoxicity Using Perfusion and Metabolic Imaging. Front Cardiovasc Med 2022; 9:813883. [PMID: 35198613 PMCID: PMC8858802 DOI: 10.3389/fcvm.2022.813883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/06/2022] [Indexed: 12/16/2022] Open
Abstract
Cardio-oncology requires a good knowledge of the cardiotoxicity of anticancer drugs, their mechanisms, and their diagnosis for better management. Anthracyclines, anti-vascular endothelial growth factor (VEGF), alkylating agents, antimetabolites, anti-human epidermal growth factor receptor (HER), and receptor tyrosine kinase inhibitors (RTKi) are therapeutics whose cardiotoxicity involves several mechanisms at the cellular and subcellular levels. Current guidelines for anticancer drugs cardiotoxicity are essentially based on monitoring left ventricle ejection fraction (LVEF). However, knowledge of microvascular and metabolic dysfunction allows for better imaging assessment before overt LVEF impairment. Early detection of anticancer drug-related cardiotoxicity would therefore advance the prevention and patient care. In this review, we provide a comprehensive overview of the cardiotoxic effects of anticancer drugs and describe myocardial perfusion, metabolic, and mitochondrial function imaging approaches to detect them before over LVEF impairment.
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Affiliation(s)
- Farah Cadour
- Aix-Marseille Université, CNRS, CRMBM, Marseille, France
- APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France
| | - Franck Thuny
- Aix-Marseille University, University Mediterranean Center of Cardio-Oncology, Unit of Heart Failure and Valvular Heart Diseases, Department of Cardiology, North Hospital, Assistance Publique - Hôpitaux de Marseille, Centre for CardioVascular and Nutrition Research (C2VN), Inserm 1263, Inrae 1260, Marseille, France
| | - Joevin Sourdon
- Aix-Marseille Université, CNRS, CRMBM, Marseille, France
- APHM, Hôpital Universitaire Timone, CEMEREM, Marseille, France
- *Correspondence: Joevin Sourdon
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Mathew RC, Bourque JM, Salerno M, Kramer CM. Cardiovascular Imaging Techniques to Assess Microvascular Dysfunction. JACC Cardiovasc Imaging 2020; 13:1577-1590. [PMID: 31607665 PMCID: PMC7148179 DOI: 10.1016/j.jcmg.2019.09.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 08/02/2019] [Accepted: 09/03/2019] [Indexed: 02/08/2023]
Abstract
The understanding of microvascular dysfunction without evidence of epicardial coronary artery disease pales in comparison with that of obstructive epicardial coronary artery disease. A primary limitation in the past had been the lack of development of noninvasive methods of detecting and quantifying microvascular dysfunction. This limitation has particularly affected the ability to study the pathophysiology, morbidity, and treatment of this disease. More recently, almost all of the noninvasive cardiac imaging modalities have been used to quantify blood flow and advance understanding of microvascular dysfunction.
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Affiliation(s)
- Roshin C Mathew
- Department of Medicine (Cardiology), University of Virginia Health System, Charlottesville, Virginia
| | - Jamieson M Bourque
- Department of Medicine (Cardiology), University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia
| | - Michael Salerno
- Department of Medicine (Cardiology), University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia; Department of Biomedical Engineering, University of Virginia Health System, Charlottesville, Virginia
| | - Christopher M Kramer
- Department of Medicine (Cardiology), University of Virginia Health System, Charlottesville, Virginia; Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, Virginia.
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Kermott CA, Schroeder DR, Kopecky SL, Behrenbeck TR. Cardiorespiratory Fitness and Coronary Artery Calcification in a Primary Prevention Population. Mayo Clin Proc Innov Qual Outcomes 2019; 3:122-130. [PMID: 31193905 PMCID: PMC6543459 DOI: 10.1016/j.mayocpiqo.2019.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/02/2019] [Accepted: 04/03/2019] [Indexed: 11/26/2022] Open
Abstract
Objective To elucidate whether cardiorespiratory fitness (CRF) is protective or contributory to coronary artery disease plaque burden. Patients and Methods Study participants were working middle-aged men from the Mayo Clinic Executive Health Program who underwent coronary artery calcium (CAC) assessment and exercise treadmill testing for risk stratification. Data from January 1, 1995, through December 31, 2008, were considered. The CAC assessment score was used for lifelong plaque burden analysis; functional aerobic capacity (FAC) from treadmill testing was analyzed as 4 ranked categories of CRF. Known risk factors for cardiovascular disease, including family history, were also considered. Results In 2946 male patients in this retrospective, cross-sectional, observational study, known cardiovascular risk factor profiles and risk calculations tended to uniformly improve with increasing CRF, defined by the FAC level. Only the above-average group, or the third of 4 levels, was found consistently lower than other levels of FAC for CAC scores. The above-average group also had statistical significance after controlling for age, body mass index, and family history of coronary artery disease in a U-shaped distribution rather than the expected linear dose-response relationship. Plaque burden was significantly increased in patients with the highest FAC level (P=.005) compared with the above-average group despite the observed maximal risk factor optimization in all known conventional cardiovascular risk factors. Conclusion For men, maximal CRF is associated with increased atherosclerosis, established with CAC scores. By comparison, average-to-moderate CRF appears to be cardioprotective regardless of either age or the influence of other contributing, recognized cardiac risk factors.
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Affiliation(s)
- Cindy A Kermott
- Division of Preventive, Occupational, and Aerospace Medicine, Mayo Clinic, Rochester, MN
| | - Darrell R Schroeder
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | - Thomas R Behrenbeck
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.,Eka Medical Group, Jakarta, Indonesia
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Chung KS, Nguyen PK. Non-invasive measures of coronary microcirculation: Taking the long road to the clinic. J Nucl Cardiol 2018; 25:2112-2115. [PMID: 28721646 PMCID: PMC6148395 DOI: 10.1007/s12350-017-0972-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 06/16/2017] [Indexed: 01/05/2023]
Abstract
Although coronary microvascular disease is now a well-recognized entity that is associated with significant morbidity and mortality, current non-invasive strategies cannot differentiate between coronary microvascular disease (CMD) and obstructive epicardial stenosis. While the evaluation of intramyocardial blood volume as a surrogate measure for microvascular health may have limited sensitivity in early-stage disease, this strategy does enable the diagnosis of CMD in the presence of concurrent epicardial disease, bringing us one step further toward improving the management of this disease. Herein, we discuss the advantages and limitations of current non-invasive measures of CMD and the need for further investment in bringing these technologies to the bedside.
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Affiliation(s)
- Kieran S Chung
- Cardiology Section, Veterans Affairs Palo Alto Health Care Administration, Palo Alto, CA, USA
| | - Patricia K Nguyen
- Cardiology Section, Veterans Affairs Palo Alto Health Care Administration, Palo Alto, CA, USA.
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, 300 Pasteur Drive, Grant Building S114, Stanford, CA, 94301, USA.
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Chase SC, Taylor BJ, Cross TJ, Coffman KE, Olson LJ, Johnson BD. Influence of Thoracic Fluid Compartments on Pulmonary Congestion in Chronic Heart Failure. J Card Fail 2017; 23:690-696. [PMID: 28716688 DOI: 10.1016/j.cardfail.2017.07.394] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/28/2017] [Accepted: 07/11/2017] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Pulmonary congestion is a common finding of heart failure (HF), but it remains unclear how pulmonary and heart blood volumes (Vp and Vh, respectively) and extravascular lung water (EVLW) change in stable HF and affect lung function. METHODS Fourteen patients with HF (age 68 ± 11 y, LVEF 33 ± 8%) and 12 control subjects (age 65 ± 9 y) were recruited. A pulmonary function test, thoracic computerized tomographic (CT) scan, and contrast perfusion scan were performed. From the thoracic scan, a histogram of CT attenuation of lung tissue was generated and skew, kurtosis, and full-width half-max (FWHM) calculated as surrogates of EVLW. Blood volumes were calculated from the transit time of the contrast through the great vessels of the heart. RESULTS Patients with HF had greater Vp and Vh (Vp 0.55 ± 0.21 L vs 0.41 ± 0.13 L; Vh 0.53 ± 0.33 L vs 0.40 ± 0.15 L) and EVLW (skew 3.2 ± 0.5 vs 3.7 ± 0.7; kurtosis 19.4 ± 6.6 vs 25.9 ± 9.4; FWHM 73 ± 13 HU vs 59 ± 9 HU). Spirometric measures were decreased in HF (percentage of predicted: forced vital capacity 86 ± 17% vs 104 ± 9%; forced expiratory volume in 1 second 83 ± 20% vs 105 ± 11%; maximal mid-expiratory flow 82 ± 42% vs 115 ± 43%). Vp was associated with decreased expiratory flows, and EVLW was associated with decreased lung volumes. CONCLUSIONS Congestion in stable patients with HF includes expanded Vp and Vh and increased EVLW associated with reductions in lung volumes and expiratory flows.
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Affiliation(s)
- Steven C Chase
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Bryan J Taylor
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Troy J Cross
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Kirsten E Coffman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Lyle J Olson
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Bruce D Johnson
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
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Vliegenthart R, De Cecco CN, Wichmann JL, Meinel FG, Pelgrim GJ, Tesche C, Ebersberger U, Pugliese F, Bamberg F, Choe YH, Wang Y, Schoepf UJ. Dynamic CT myocardial perfusion imaging identifies early perfusion abnormalities in diabetes and hypertension: Insights from a multicenter registry. J Cardiovasc Comput Tomogr 2016; 10:301-8. [DOI: 10.1016/j.jcct.2016.05.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 05/17/2016] [Accepted: 05/22/2016] [Indexed: 11/27/2022]
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Apostolidou C, Adamopoulos K, Lymperaki E, Iliadis S, Papapreponis P, Kourtidou-Papadeli C. Cardiovascular risk and benefits from antioxidant dietary intervention with red wine in asymptomatic hypercholesterolemics. Clin Nutr ESPEN 2015; 10:e224-e233. [PMID: 28531467 DOI: 10.1016/j.clnesp.2015.08.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 08/25/2015] [Accepted: 08/27/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND & AIMS The role of red wine in cardiovascular risk prevention has been documented by several epidemiological studies in patients and normocholesterolemic healthy individuals. However, it is unclear whether hypercholesterolemic individuals free of cardiovascular disease would equally benefit from moderate red wine consumption to prevent atherosclerosis and the development of cardiovascular disease. METHODS Forty (40) healthy male and female volunteers were recruited, divided into 2 age-adjusted groups according to their total cholesterol levels; in asymptomatic hypercholesterolemics (AHC), and normocholesterolemics (NC). Total Antioxidant Capacity (TAC), Lipid profile, Vitamin E, and cardiovascular risk indexes (Low Density Lipoproteins (LDL)/High Density Lipoproteins (HDL) and Vitamin E/Total Cholesterol (TC) were evaluated in the blood serum of all subjects prior to and 1 month after once daily red wine consumption as well as prior to and after being given a placebo drink following a 1 month wash out period. RESULTS TAC significantly increased after the intervention in all subjects in AHC and NC group with a mean difference (post-pre) 1.78 mmol/l and 0.87 mmol/l, respectively. Vitamin E significantly increased especially in AHC group (13.1% increase) compared to NC group (5.41%) after red wine consumption, with higher increase in the AHC group. There was marginal significant treatment effect (decrease) on fasting LDL/HDL ratio (p = 0.05) and a statistically significant increase on Vitamin E/TC ratio relative to drinking placebo for NC (p < 0.005) and AHC group (p < 0.002). CONCLUSIONS Asymptomatic hypercholesterolemic (AHC) individuals are more likely to develop cardiovascular disease as presented by high cholesterol levels in addition to the presence of low baseline serum α-tocopherol (vitamin E) concentrations, leading to atherosclerosis. AHC individuals following an early dietary intervention, seem likely to reduce the risk factors for cardiovascular disease by increasing circulating concentrations of TAC and α-tocopherol (vitamin E) so as vitamin E/TC ratio increases.
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Affiliation(s)
- C Apostolidou
- Aristotle University of Thessaloniki, School of Engineering, Faculty of Chemical Engineering, Division of Technology Laboratory of Food and Process Engineering, Greece; General Chemical State Laboratory, Greece.
| | - K Adamopoulos
- Aristotle University of Thessaloniki, School of Engineering, Faculty of Chemical Engineering, Division of Technology Laboratory of Food and Process Engineering, Greece
| | - E Lymperaki
- Alexandrion Technological Educational Institute of Thessaloniki, Department of Medical Laboratories, Greece
| | - S Iliadis
- Aristotle University of Thessaloniki, School of Medicine, Greece
| | - P Papapreponis
- Theageneio Cancer Hospital of Thessaloniki, Department of Biopathology, Greece
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Miller WL, Behrenbeck TR, McCollough CH, Williamson EE, Leng S, Kline TL, Ritman EL. Coronary microcirculation changes in non-ischemic dilated cardiomyopathy identified by novel perfusion CT. Int J Cardiovasc Imaging 2015; 31:881-8. [PMID: 25712168 DOI: 10.1007/s10554-015-0619-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/09/2015] [Indexed: 11/29/2022]
Abstract
Intramyocardial microvessels demonstrate functional changes in cardiomyopathies. However, clinical computed tomography (CT) does not have adequate spatial resolution to assess the microvessels. Our hypothesis is that these functional changes manifest as altered heterogeneity of the spatial distribution of arteriolar perfusion territories. Our goal was to determine whether the spatial analysis of perfusion CT could clinically detect changes in the function and structure of the intramyocardial microcirculation in a non-ischemic dilated cardiomyopathy (DCM). Two groups were studied: (1) a Control group (12 male plus 12 female) with no risk factors nor evidence of coronary artery disease, and (2) a DCM group (12 male plus 12 female) with left ventricular ejection fraction ≤40% and no evidence of coronary artery disease. Using the CT scan, the LV free wall thickness and its radius of curvature were measured. The DCM group was sub divided into those with LV free wall thickness <11.5 mm and those with thickness ≥11.5 mm. In the myocardial opacification phase of the CT scan sequence, myocardial perfusion (F) and intramyocardial blood volume (Bv) for multiple intramyocardial regions were computed. No significant differences between the groups were demonstrable in overall myocardial F or Bv. However, the myocardial regional data showed significantly increased spatial heterogeneity in the DCM group when compared to the Control group. The findings demonstrate that altered function of the subresolution intramyocardial microcirculation can be quantified with myocardial perfusion CT and that significant changes in these parameters occur in the DCM subjects with LV wall thickness greater than 11.5 mm.
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Affiliation(s)
- Wayne L Miller
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
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