Cardiac magnetic resonance relaxometry compared to left ventricular ejection fraction in the identification of anthracycline related cardiac changes: a systematic review and meta-analysis

Background

Anthracyclines are associated with cancer therapeutics related cardiac dysfunction (CTRCD). The identification of CTRCD currently uses a change in left ventricular ejection fraction (LVEF). Myocardial damage associated with anthracyclines include myocardial inflammation and oedema. This can be assessed using cardiac magnetic resonance (CMR) relaxometry techniques; T1 and T2 mapping and extracellular volume (ECV) fraction.

Purpose

In this meta-analysis, we compared the magnitude of the changes in LVEF and CMR relaxometry techniques wihtin a month of anthracycline therapy completion.

Methods

We performed a structured literature review as per the PRISMA guidelines across three databases (EMBASE, MEDLINE, and SCOPUS) for studies evaluating CMR relaxometry parameter at baseline and soon after completion of anthracycline therapy (3–5 months post baseline). CMR parameters pre and post anthracycline-based chemotherapy were abstracted. A random effects model was used to pool mean difference (MD) in LVEF and ECV given standardisation in imaging acquisition techniques. A random effects model was used to pool standardized mean difference (SMD) in LVEF, T1, T2 and ECV after anthracycline to adjust for variations in imaging techniques and comparison between techniques.

Results

A total of 174 patients were included from seven studies. 91% were female with a mean age of 55.6 years. The pooled MD in LVEF and ECV was −3.15% [95% CI −4.99, −1.31] and 1.61% [0.90, 2.32], respectively. The pooled SMD in LVEF, T1, T2 and ECV was −0.61 [−0.96, −0.25] 0.34 [0.04, 0.63], 0.67 [0.12,1.21], 0.6 [0.31, 0.89], respectively (Table 1).

Conclusions

T2 mapping, ECV and LVEF can identify early myocardial changes better than T1 mapping. These changes suggest there is marked oedema in the myocardial injury from anthracycline therapy. Whilst these findings support the role of CMR relaxometry in identifying CTRCD, further studies are required.

Funding Acknowledgement

Type of funding sources: None.

Influence of silver grain size, roughness, and profile on the extraordinary fluorescence enhancement capabilities of grating coupled surface plasmon resonance

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The genetics of NOD-like receptors in Crohn's disease

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Mapping QTLs for root morphology of a rice population adapted to rainfed lowland conditions

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Polyvalent cationic metals induce the rate of transferrin-independent iron acquisition by HL-60 cells

The trivalent metals iron, aluminum, and gallium greatly increase the rate of iron acquisition from low molecular weight chelates by human myeloid cells. The present study explores the mechanism responsible. Gallium-induced iron acquisition was shown to lead to stable cellular association of iron, the magnitude of which varied with the chelate to which the iron was bound. The majority of this iron initially associated with the plasma membrane. Cellular depletion of ATP did not affect the response to gallium nor did it require the continued presence of extracellular gallium. However, continued cell association of gallium was needed as subsequent cellular exposure to metal chelators resulted in a rapid loss of the "induced" phenotype. Other trivalent metals (lanthanum and gadolinium) and tetravalent metals (tin and zirconium) but not divalent metals also induced iron acquisition. Neither enhanced iron reduction nor protein kinase C or tyrosine kinases appeared involved in gallium-mediated induction of iron acquisition. Exposure of HL-60 cells to polyvalent cationic metals results in a dramatic and sustained increase in the rate of iron acquisition from low molecular weight chelating agents. This could be important for the rapid clearance of iron by phagocytes from the extracellular environment at sites of local tissue damage.