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Cannizzaro MT, Inserra MC, Passaniti G, Celona A, D'Angelo T, Romeo P, Basile A. Role of advanced cardiovascular imaging in chemotherapy-induced cardiotoxicity. Heliyon 2023; 9:e15226. [PMID: 37095987 PMCID: PMC10121465 DOI: 10.1016/j.heliyon.2023.e15226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/29/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023] Open
Abstract
The development of cardiotoxicity induced by cancer treatments has emerged as a significant clinical problem, both in the short run, as it may influence drug administration in chemotherapeutic protocols, and in the long run, because it may determine adverse cardiovascular outcomes in survivors of various malignant diseases. Therefore, early detection of anticancer drug-related cardiotoxicity is an important clinical target to improve prevention of adverse effects and patient care. Today, echocardiography is the first-line cardiac imaging techniques used for identifying cardiotoxicity. Cardiac dysfunction, clinical and subclinical, is generally diagnosed by the reduction of left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). However, myocardial injury detected by echocardiography is preceded by other alterations, such as myocardial perfusion and mitochondrial and metabolic dysfunction, that can only be recognized by second-level imaging techniques, like cardiac magnetic resonance (CMR) and nuclear imaging, which, using targeted radiotracers, may help to provide information on the specific mechanisms of cardiotoxicity. In this review, we focus on the current and emerging role of CMR, as a critical diagnostic tool of cardiotoxicity in the very early phase, due to its availability and because it allows the contemporary detection of functional alterations, tissue alterations (mainly performed using T1, T2 mapping with the evaluation of extracellular volume-ECV) and perfusional alteration (evaluated with rest-stress perfusion) and, in the next future, even metabolic changes. Moreover, in the subsequent future, the use of Artificial Intelligence and big data on imaging parameters (CT, CMR) and oncoming molecular imaging datasets, including differences for gender and countries, may help predict cardiovascular toxicity at its earliest stages, avoiding its progression, with precise tailoring of patients' diagnostic and therapeutic pathways.
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Affiliation(s)
| | | | | | | | - Tommaso D'Angelo
- Diagnostic and Interventional Radiology Unit, BIOMORF Department, University Ospital “Policlinico G. Martino”, Messina, Italy
| | - Placido Romeo
- Radiology Department of AO “San Marco”, A.U.O. Policlinico “G.Rodolico-San Marco”, Catania, Italy
| | - Antonio Basile
- University of Catania, Department of Surgical and Medical Sciences and Advanced Technologies ‘G.F. Ingrassia’, Italy
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Gonciar D, Mocan L, Zlibut A, Mocan T, Agoston-Coldea L. Cardiotoxicity in HER2-positive breast cancer patients. Heart Fail Rev 2021; 26:919-935. [PMID: 33405000 DOI: 10.1007/s10741-020-10072-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 01/22/2023]
Abstract
Due to the recent advances in diagnosis and management of patients with HER2-positive breast cancer, especially through novel HER2-targeted agents, cardiotoxicity becomes an emerging problem. Although chemotherapy significantly increases survival, the risk of cardiovascular disease development is high and still underestimated and could imply treatment discontinuation. Frequently, due to lack of rigorous diagnosis strategies, cardiotoxicity assessment is delayed, and, moreover, the efficacy of current therapy options in restoring heart function is questionable. For a comprehensive risk assessment, it is vital to characterize the clinical spectrum of HER2-targeted agents and anthracyclines, as well as their pathogenic pathways involved in cardiotoxicity. Advanced cardiovascular multimodal imaging and circulating biomarkers plays primary roles in early assessing cardiotoxicity and also in guiding specific preventive measures. Even though the knowledge in this field is rapidly expanding, there are still questions that arise regarding the optimal approach in terms of timing and methods. The aim of the current review aims to providean overview of currently available data.
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Affiliation(s)
- Diana Gonciar
- 2nd Department of Internal Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Lucian Mocan
- 3rd Surgery Department, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Nanomedicine, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Alexandru Zlibut
- 2nd Department of Internal Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Teodora Mocan
- Physiology Department, Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Nanomedicine, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Lucia Agoston-Coldea
- 2nd Department of Internal Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
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Trofenciuc NM, Bordejevic AD, Tomescu MC, Petrescu L, Crisan S, Geavlete O, Mischie A, Onel AFM, Sasu A, Pop-Moldovan AL. Toll-like receptor 4 (TLR4) expression is correlated with T2* iron deposition in response to doxorubicin treatment: cardiotoxicity risk assessment. Sci Rep 2020; 10:17013. [PMID: 33046755 PMCID: PMC7552385 DOI: 10.1038/s41598-020-73946-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/23/2020] [Indexed: 11/16/2022] Open
Abstract
Although doxorubicin (Dox) is an effective antitumor antibiotic in the anthracycline class, it often induces the undesirable side effect of cardiomyopathy leading to congestive heart failure, which limits its clinical use. The primary goal of this study is to evaluate a reliable translational method for Dox-induced cardiotoxicity (CTX) screening, aiming to identify a high-risk population and to discover new strategies to predict and investigate this phenomenon. Early identification of the presence of iron deposits and genetic and environmental triggers that predispose individuals to increased risk of Dox-induced CTX (e.g., overexpression of Toll-like receptor 4 (TLR4)) will enable the early implementation of countermeasure therapy, which will improve the patient's chance of survival. Our cohort consisted of 25 consecutive patients with pathologically confirmed cancer undergoing Dox chemotherapy and 12 control patients. The following parameters were measured: serum TLR4 (baseline), serum transferrin (baseline and 6-week follow-up) and iron deposition (baseline and 6-week follow-up). The average number of gene expression units was 0.121 for TLR4 (range 0.051-0.801). We subsequently correlated serum TLR4 levels in our cohort with myocardial iron overload using the cardiac magnetic resonance (CMR) T2* technique, the ventricular function (% ejection fraction, %EF) and serum transferrin levels. There is a strong negative linear relationship between serum TLR4 and CMR T2* values (r = - 0.9106, ****P < 0.0001). There is also a linear correlation (either positive or negative) with EF and transferrin; no established relationship related to the sex of the patients was found. Patients with elevated serum TLR4 at baseline also exhibited an increase in serum transferrin levels and Dox-induced left ventricular dysfunction with a decreased EF (< 50%); this phenomenon was observed in 7 of 25 patients (28%) at the 6-week follow-up. There were no significant differences or correlations based on sex. We concluded that there is a direct relationship between Dox-induced CTX (indicated by elevated serum TLR4) and the times (ms) for T2* (decreases in which correspond to immediate and rapid iron overload).
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Affiliation(s)
- Nelu-Mihai Trofenciuc
- "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
- Institute of Cardiovascular Disease, Timisoara, Romania
| | - Aurora Diana Bordejevic
- "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
- Institute of Cardiovascular Disease, Timisoara, Romania
| | - Mirela Cleopatra Tomescu
- "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
- Timisoara Municipal Emergency Clinical Hospital, Timisoara, Romania
| | - Lucian Petrescu
- "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania
- Institute of Cardiovascular Disease, Timisoara, Romania
| | - Simina Crisan
- "Victor Babeş" University of Medicine and Pharmacy, Timisoara, Romania.
- Institute of Cardiovascular Disease, Timisoara, Romania.
| | - Oliviana Geavlete
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
- Institute of Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu, Bucharest, Romania
| | - Alexandru Mischie
- Centre Hospitalier de Montluçon, Invasive Cardiology Unit, Cardiology Department, Montluçon, France
| | - Alexandru Fica Mircea Onel
- "Vasile Goldis" Western University of Arad, Arad, Romania
- Arad County Clinical Emergency Hospital, Hematology Department, Arad, Romania
| | - Alciona Sasu
- "Vasile Goldis" Western University of Arad, Arad, Romania
- Arad County Clinical Emergency Hospital, Hematology Department, Arad, Romania
| | - Adina Ligia Pop-Moldovan
- "Vasile Goldis" Western University of Arad, Arad, Romania
- Arad County Clinical Emergency Hospital, Cardiology Department, Arad, Romania
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Differentiating Nonischemic Dilated Cardiomyopathy With Incidental Infarction From Ischemic Cardiomyopathy by Geometric Indices Derived From Cardiovascular Magnetic Resonance. J Thorac Imaging 2020; 36:248-253. [PMID: 32960835 DOI: 10.1097/rti.0000000000000560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE The purpose of this study was to differentiate nonischemic dilated cardiomyopathy with incidental myocardial infarction (NICM with incidental MI) from ischemic cardiomyopathy (ICM) by integrating left ventricular (LV) geometric indices and ischemic late gadolinium enhancement (LGE), obtained from cardiac magnetic resonance (CMR) imaging. MATERIALS AND METHODS All subjects were studied on a 1.5 Tesla magnetic resonance imaging scanner. All patients had an LV ejection fraction (LVEF) <50% with LV dilation. LV end-diastolic volume (LVEDV), LVEDV index (LVEDVi), LVEF, the number and distribution of ischemic LGE segments, and ratios of volumetric and functional indices to ischemic LGE segments were determined. Logistic regression was used to detect the independent predictor of ICM. Receiver operating characteristic analysis differentiated NICM with incidental MI from ICM. RESULTS Of a total of 63 patients enrolled, 45 patients had ICM, and 18 patients had NICM with incidental MI. Both groups had similar LVEF. Compared with ICM, NICM with incidental MI had more LV dilation, whereas ICM had more ischemic LGE segments. A higher number of ischamic LGE segments remained an independent predictor of ICM (odds ratio: 18.2, 95% confidence interval: 1.64-201.34, P=0.018). The optimal cut-off value for detecting NICM with incidental MI is the ratio of LVEDVi to the number of ischemic LGE segments over 25 mL/m2/segment (sensitivity 100%, specificity 91%, P<0.0001). CONCLUSION Patients with NICM with incidental MI can be reliably distinguished from ICM using the ratio of LVEDVi divided by the number of ischemic LGE segments. This technique may improve diagnosis and help aid management of patients with cardiomyopathy and coexistent coronary artery disease.
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Antonelli A, Szwargulski P, Scarpa ES, Thieben F, Cordula G, Ambrosi G, Guidi L, Ludewig P, Knopp T, Magnani M. Development of long circulating magnetic particle imaging tracers: use of novel magnetic nanoparticles and entrapment into human erythrocytes. Nanomedicine (Lond) 2020; 15:739-753. [PMID: 32207374 DOI: 10.2217/nnm-2019-0449] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Aim: Magnetic particle imaging (MPI) is highly promising for biomedical applications, but optimal tracers for MPI, namely superparamagnetic iron oxide-based contrast agents, are still lacking. Materials & methods: The encapsulation of commercially available nanoparticles, specifically synomag®-D and perimag®, into human red blood cells (RBCs) was performed by a hypotonic dialysis and isotonic resealing procedure. The amounts of superparamagnetic iron oxide incorporated into RBCs were determined by Fe quantification using nuclear magnetic resonance and magnetic particle spectroscopy. Results: Perimag-COOH nanoparticles were identified as the best nanomaterial for encapsulation in RBCs. Perimag-COOH-loaded RBCs proved to be viable cells showing a good magnetic particle spectroscopy performance, while the magnetic signal of synomag-D-COOH-loaded RBCs dropped sharply. Conclusion: Perimag-COOH-loaded RBCs could be a potential tool for MPI diagnostic applications.
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Affiliation(s)
- Antonella Antonelli
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Via Saffi 2, 61029, Urbino (PU), Italy
| | - Patryk Szwargulski
- Section for Biomedical Imaging, University Medical Center Hamburg-Eppendorf, Lottestr. 55, 22529, Hamburg, Germany.,Institute for Biomedical Imaging, Hamburg University of Technology, Am Schwarzenberg-Campus 3, 21073, Hamburg, Germany
| | - Emanuele-Salvatore Scarpa
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Via Saffi 2, 61029, Urbino (PU), Italy
| | - Florian Thieben
- Section for Biomedical Imaging, University Medical Center Hamburg-Eppendorf, Lottestr. 55, 22529, Hamburg, Germany.,Institute for Biomedical Imaging, Hamburg University of Technology, Am Schwarzenberg-Campus 3, 21073, Hamburg, Germany
| | - Grüttner Cordula
- Micromod Partikeltechnologie GmbH, Friedrich-Barnewitz-Str. 4 D-18119, Rostock, Germany
| | - Gianluca Ambrosi
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Via Saffi 2, 61029, Urbino (PU), Italy
| | - Loretta Guidi
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Via Saffi 2, 61029, Urbino (PU), Italy
| | - Peter Ludewig
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20251, Hamburg, Germany
| | - Tobias Knopp
- Section for Biomedical Imaging, University Medical Center Hamburg-Eppendorf, Lottestr. 55, 22529, Hamburg, Germany.,Institute for Biomedical Imaging, Hamburg University of Technology, Am Schwarzenberg-Campus 3, 21073, Hamburg, Germany
| | - Mauro Magnani
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Via Saffi 2, 61029, Urbino (PU), Italy
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Imaging in Cardiothoracic Oncologic Therapy. J Thorac Imaging 2019; 35:2-3. [PMID: 31855946 DOI: 10.1097/rti.0000000000000464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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