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17.05.2022 | Cardiac

Myocardial microvascular function assessed by CMR first-pass perfusion in patients treated with chemotherapy for gynecologic malignancies

verfasst von: Meng-Xi Yang, Qing-Li Li, Dan-Qing Wang, Lu Ye, Ke-Min Li, Xiao-Juan Lin, Xue-Sheng Li, Chuan Fu, Xin-Mao Ma, Ying-Kun Guo, Ru-Tie Yin, Zhi-Gang Yang

Erschienen in: European Radiology | Ausgabe 10/2022

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Abstract

Objectives

Cancer chemotherapy potentially increases the risk of myocardial ischemia. This study assessed myocardial microvascular function by cardiac magnetic resonance (CMR) first-pass perfusion in patients treated with chemotherapy for gynecologic malignancies.

Methods

A total of 81 patients treated with chemotherapy for gynecologic malignancies and 39 healthy volunteers were prospectively enrolled and underwent CMR imaging. Among the patients, 32 completed CMR follow-up, with a median interval of 6 months. The CMR sequences comprised cardiac cine, rest first-pass perfusion, and late gadolinium enhancement.

Results

There were no significant differences in the baseline characteristics between the patients and normal controls (all p > 0.05). Compared with the normal controls, the patients had a lower myocardial perfusion index (PI) (13.62 ± 2.01% vs. 12% (11 to 14%), p = 0.001) but demonstrated no significant variation with an increase in the number of chemotherapy cycles at follow-up (11.79 ± 2.36% vs. 11.19 ± 2.19%, p = 0.234). In multivariate analysis with adjustments for clinical confounders, a decrease in the PI was independently associated with chemotherapy treatment (β = − 0.362, p = 0.002) but had no correlation with the number of chemotherapy cycles (r = − 0.177, p = 0.053).

Conclusion

Myocardial microvascular dysfunction was associated with chemotherapy treatment in patients with gynecologic malignancies, and can be assessed and monitored by rest CMR first-pass perfusion.

Key Points

• Chemotherapy was associated with but did not aggravate myocardial microvascular dysfunction in patients with gynecologic malignancies.

• Rest CMR first-pass perfusion is an ideal modality for assessing and monitoring alterations in myocardial microcirculation during chemotherapy treatment.

Zamorano JL, Lancellotti P, Rodriguez Muñoz D et al (2017) 2016 ESC Position paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: the task force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur J Heart Fail 19(1):9–42PubMedCrossRef

Yeh ET, Bickford CL (2009) Cardiovascular complications of cancer therapy: incidence, pathogenesis, diagnosis, and management. J Am Coll Cardiol 16;53(24):2231-2247

Bellinger AM, Arteaga CL, Force T et al (2015) Cardio-oncology: how new targeted cancer therapies and precision medicine can inform cardiovascular discovery. Circulation 8 132(23):2248–2258CrossRef

Jordan JH, Todd RM, Vasu S, Hundley WG (2018) Cardiovascular magnetic resonance in the oncology patient. JACC Cardiovasc Imaging 11(8):1150–1172PubMedPubMedCentralCrossRef

Siegel RL, Miller KD, Jemal A (2020) Cancer statistics, 2020. CA Cancer J Clin 70(1):7–30PubMedCrossRef

Morbidelli L, Donnini S, Ziche M (2016) Targeting endothelial cell metabolism for cardio-protection from the toxicity of antitumor agents. Cardiooncology 15;2(1):3.

Schrader C, Keussen C, Bewig B, von Freier A, Lins M (2005) Symptoms and signs of an acute myocardial ischemia caused by chemotherapy with paclitaxel (Taxol) in a patient with metastatic ovarian carcinoma. Eur J Med Res 16 10(11):498–501

Hanchate LP, Sharma SR, Madyalkar S (2017) Cisplatin induced acute myocardial infarction and dyslipidemia. J Clin Diagn Res 11(6):OD05–OD07. https://doi.org/10.7860/JCDR/2017/25546.10025PubMedPubMedCentralCrossRef

Monsuez JJ, Charniot JC, Vignat N, Artigou JY (2010) Cardiac side-effects of cancer chemotherapy. Int J Cardiol 24 144(1):3–15CrossRef

10.

Meinardi MT, Gietema JA, van der Graaf WT et al (2000) Cardiovascular morbidity in long-term survivors of metastatic testicular cancer. J Clin Oncol 18(8):1725–1732PubMedCrossRef

11.

Rowinsky EK, McGuire WP, Guarnieri T, Fisherman JS, Christian MC, Donehower RC (1991) Cardiac disturbances during the administration of taxol. J Clin Oncol 9(9):1704–1712PubMedCrossRef

12.

Arbuck SG, Strauss H, Rowinsky E et al (1993) A reassessment of cardiac toxicity associated with Taxol. J Natl Cancer Inst Monogr 15:117–130

13.

Schindler TH, Dilsizian V (2020) Coronary microvascular dysfunction: clinical considerations and noninvasive diagnosis. JACC Cardiovasc Imaging 13(1 Pt 1):140–155PubMedCrossRef

14.

Bethke A, Shanmuganathan L, Andersen GØ et al (2019) Microvascular perfusion in infarcted and remote myocardium after successful primary PCI: angiographic and CMR findings. Eur Radiol 29(2):941–950PubMedCrossRef

15.

Chiribiri A, Leuzzi S, Conte MR et al (2015) Rest perfusion abnormalities in hypertrophic cardiomyopathy: correlation with myocardial fibrosis and risk factors for sudden cardiac death. Clin Radiol 70(5):495–501PubMedPubMedCentralCrossRef

16.

Li R, Yang ZG, Wen LY et al (2016) Regional myocardial microvascular dysfunction in cardiac amyloid light-chain amyloidosis: assessment with 3 T cardiovascular magnetic resonance. J Cardiovasc Magn Reson 18:16PubMedPubMedCentralCrossRef

17.

Jiang L, Wang J, Liu X et al (2020) The combined effects of cardiac geometry, microcirculation, and tissue characteristics on cardiac systolic and diastolic function in subclinical diabetes mellitus-related cardiomyopathy. Int J Cardiol 320:112–118PubMedCrossRef

18.

DeSa TB, Abbasi MA, Blaisdell JA et al (2020) Semi-quantitative myocardial perfusion MRI in heart transplant recipients at rest: repeatability in healthy controls and assessment of cardiac allograft vasculopathy. Clin Imaging 61:62–68PubMedCrossRef

19.

Eitel I, Pöss J, Jobs A et al (2015) Left ventricular global function index assessed by cardiovascular magnetic resonance for the prediction of cardiovascular events in ST-elevation myocardial infarction. J Cardiovasc Magn Reson 17:62PubMedPubMedCentralCrossRef

20.

Haslbauer JD, Lindner S, Valbuena-Lopez S et al (2019) CMR imaging biosignature of cardiac involvement due to cancer-related treatment by T1 and T2 mapping. Int J Cardiol 275:179–186PubMedCrossRef

21.

Fallah-Rad N, Walker JR, Wassef A et al (2011) The utility of cardiac biomarkers, tissue velocity and strain imaging, and cardiac magnetic resonance imaging in predicting early left ventricular dysfunction in patients with human epidermal growth factor receptor II-positive breast cancer treated with adjuvant trastuzumab therapy. J Am Coll Cardiol 57(22):2263–2270PubMedCrossRef

22.

Lechner D, Kollars M, Gleiss A, Kyrle PA, Weltermann A (2007) Chemotherapy induced thrombin generation via procoagulant endothelial microparticles is independent of tissue factor activity. J Thromb Haemost 5:2445–2452PubMedCrossRef

23.

Ito H, Okafuji T, Suzuki T (1995) Vitamin E prevents endothelial injury associated with cisplatin injection into the superior mesenteric artery of rats. Heart Vessels 10:178–184PubMedCrossRef

24.

Majzner K, Wójcik T, Szafraniec E et al (2015) Raman microspectroscopic investigation on nuclear accumulation of doxorubicin, daunorubicin and their epimers in endothelium; relationship with cytotoxicity. Analyst 140:2302–2310PubMedCrossRef

25.

Volkova M, Russell R 3rd (2011) Anthracycline cardiotoxicity: prevalence, pathogenesis and treatment. Curr Cardiol Rev 7(4):214–220PubMedPubMedCentralCrossRef

26.

Friedberg EC (1995) Out of the shadows and into the light: the emergence of DNA repair. Trends Biochem Sci 20:381PubMedCrossRef

27.

Gayed IW, Liu HH, Yusuf SW et al (2006) The prevalence of myocardial ischemia after concurrent chemoradiation therapy as detected by gated myocardial perfusion imaging in patients with esophageal cancer. J Nucl Med 47(11):1756–1762PubMed

28.

Gallucci G, Capobianco AM, Coccaro M, Venetucci A, Suriano V, Fusco V (2008) Myocardial perfusion defects after radiation therapy and anthracycline chemotherapy for left breast cancer: a possible marker of microvascular damage. Three cases and review of the literature. Tumori 94(1):129–133PubMedCrossRef

29.

Dobbin SJH, Mangion K, Berry C et al (2020) Cardiotoxicity and myocardial hypoperfusion associated with anti-vascular endothelial growth factor therapies: prospective cardiac magnetic resonance imaging in patients with cancer. Eur J Heart Fail 22(7):1276–1277PubMedCrossRef

30.

Zorach B, Shaw PW, Bourque J et al (2018) Quantitative cardiovascular magnetic resonance perfusion imaging identifies reduced flow reserve in microvascular coronary artery disease. J Cardiovasc Magn Reson 20(1):14PubMedPubMedCentralCrossRef

31.

Knott KD, Seraphim A, Augusto JB et al (2020) The prognostic significance of quantitative myocardial perfusion: an artificial intelligence-based approach using perfusion mapping. Circulation 141(16):1282–1291PubMedPubMedCentral

32.

Hsu LY, Jacobs M, Benovoy M et al (2018) Diagnostic performance of fully automated pixel-wise quantitative myocardial perfusion imaging by cardiovascular magnetic resonance. JACC Cardiovasc Imaging 11(5):697–707PubMedPubMedCentralCrossRef

33.

Jensen SA, Hasbak P, Mortensen J, Sørensen JB (2010) Fluorouracil induces myocardial ischemia with increases of plasma brain natriuretic peptide and lactic acid but without dysfunction of left ventricle. J Clin Oncol 28(36):5280–5286PubMedCrossRef

34.

Chen J, Yang ZG, Xu HY, Shi K, Guo YK (2018) Assessment of left ventricular myocardial deformation by cardiac MRI strain imaging reveals myocardial dysfunction in patients with primary cardiac tumors. Int J Cardiol 253:176–182PubMedCrossRef

35.

Liu X, Yang ZG, Gao Y et al (2018) Left ventricular subclinical myocardial dysfunction in uncomplicated type 2 diabetes mellitus is associated with impaired myocardial perfusion: a contrast-enhanced cardiovascular magnetic resonance study. Cardiovasc Diabetol 17(1):139

36.

Plana JC, Thavendiranathan P, Bucciarelli-Ducci C, Lancellotti P (2018) Multi-modality imaging in the assessment of cardiovascular toxicity in the cancer patient. JACC Cardiovasc Imaging 11(8):1173–1186PubMedCrossRef

37.

Jeong D, Gladish G, Chitiboi T, Fradley MG, Gage KL, Schiebler ML (2019) MRI in cardio-oncology: a review of cardiac complications in oncologic care. J Magn Reson Imaging 50(5):1349–1366PubMedCrossRef

38.

Murthy VL, Naya M, Taqueti VR et al (2014) Effects of sex on coronary microvascular dysfunction and cardiac outcomes. Circulation 129:2518–2527PubMedPubMedCentralCrossRef

39.

Paul TK, Sivanesan K, Schulman-Marcus J (2017) Sex differences in nonobstructive coronary artery disease: recent insights and substantial knowledge gaps. Trends Cardiovasc Med 27:173–179PubMedCrossRef

40.

Shaw LJ, Bairey Merz CN, Pepine CJ et al (2006) Insights from the NHLBI-sponsored Women’s Ischemia Syndrome Evaluation (WISE) study: part I: gender differences in traditional and novel risk factors, symptom evaluation, and gender-optimized diagnostic strategies. J Am Coll Cardiol 47(Suppl):S4–S20

41.

Aziz A, Hansen HS, Sechtem U, Prescott E, Ong P (2017) Sex-related differences in vasomotor function in patients with angina and unobstructed coronary arteries. J Am Coll Cardiol 70(19):2349–2358PubMedCrossRef

42.

Wokhlu A, Pepine CJ (2016) Mental stress and myocardial ischemia: young women at risk. J Am Heart Assoc 5(9):e004196PubMedPubMedCentralCrossRef

Titel: Myocardial microvascular function assessed by CMR first-pass perfusion in patients treated with chemotherapy for gynecologic malignancies
verfasst von: Meng-Xi Yang
Qing-Li Li
Dan-Qing Wang
Lu Ye
Ke-Min Li
Xiao-Juan Lin
Xue-Sheng Li
Chuan Fu
Xin-Mao Ma
Ying-Kun Guo
Ru-Tie Yin
Zhi-Gang Yang
Publikationsdatum: 17.05.2022
Verlag: Springer Berlin Heidelberg
Erschienen in: European Radiology / Ausgabe 10/2022
Print ISSN: 0938-7994
Elektronische ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-022-08823-2

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Myocardial microvascular function assessed by CMR first-pass perfusion in patients treated with chemotherapy for gynecologic malignancies