Myocardial Strain Measurements Obtained with Fast-Strain-Encoded Cardiac Magnetic Resonance for the Risk Prediction and Early Detection of Chemotherapy-Related Cardiotoxicity Compared to Left Ventricular Ejection Fraction
<b>Background:</b> Breast and hematological cancer treatments, especially with anthracyclines, have been shown to be associated with an increased risk of cardiotoxicity (CTX). An accurate prediction of cardiotoxicity risk and early detection of myocardial injury may allow for effective c...
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2025-08-01
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| author | Daniel Lenihan James Whayne Farouk Osman Rafael Rivero Moritz Montenbruck Arne Kristian Schwarz Sebastian Kelle Pia Wülfing Susan Dent Florian Andre Norbert Frey Grigorios Korosoglou Henning Steen |
| author_facet | Daniel Lenihan James Whayne Farouk Osman Rafael Rivero Moritz Montenbruck Arne Kristian Schwarz Sebastian Kelle Pia Wülfing Susan Dent Florian Andre Norbert Frey Grigorios Korosoglou Henning Steen |
| author_sort | Daniel Lenihan |
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| description | <b>Background:</b> Breast and hematological cancer treatments, especially with anthracyclines, have been shown to be associated with an increased risk of cardiotoxicity (CTX). An accurate prediction of cardiotoxicity risk and early detection of myocardial injury may allow for effective cardioprotection to be instituted and tailored to reverse cardiac dysfunction and prevent the discontinuation of essential cancer treatments. <b>Objectives:</b> The PRoactive Evaluation of Function to Evade Cardio Toxicity (PREFECT) study sought to evaluate the ability of fast-strain-encoded (F-SENC) cardiac magnetic resonance imaging (CMR) and 2D echocardiography (2D Echo) to stratify patients at risk of CTX prior to initiating cancer treatment, detect early signs of cardiac dysfunction, including subclinical CTX (sub-CTX) and CTX, and monitor for recovery (REC) during cardioprotective therapy. <b>Methods:</b> Fifty-nine patients with breast cancer or lymphoma were prospectively monitored for CTX with F-SENC CMR and 2D Echo over at least 1 year for evidence of cardiac dysfunction during anthracycline based chemotherapy. F-SENC CMR also monitored myocardial deformation in 37 left ventricular (LV) segments to obtain a MyoHealth risk score based on both longitudinal and circumferential strain. Sub-CTX and CTX were classified based on pre-specified cardiotoxicity definitions. <b>Results:</b> CTX was observed in 9/59 (15%) and sub-CTX in 24/59 (41%) patients undergoing chemotherapy. F-SENC CMR parameters at baseline predicted CTX with a lower LVEF (57 ± 5% vs. 61 ± 5% for all, <i>p</i> = 0.05), as well as a lower MyoHealth (70 ± 9 vs. 79 ± 11 for all, <i>p</i> = 0.004) and a worse global circumferential strain (GCS) (−18 ± 1 vs. −20 ± 1 for all, <i>p</i> < 0.001). Pre-chemotherapy MyoHealth had a higher accuracy in predicting the development of CTX compared to CMR LVEF and 2D Echo LVEF (AUC = 0.85, 0.69, and 0.57, respectively). The 2D Echo parameters on baseline imaging did not stratify CTX risk. F-SENC CMR obtained good or excellent images in 320/322 (99.4%) scans. During cancer treatment, MyoHealth had a high accuracy of detecting sub-CTX or CTX (AUC = 0.950), and the highest log likelihood ratio (indicating a higher probability of detecting CTX) followed by F-SENC GLS and F-SENC GCS. CMR LVEF and CMR LV stroke volume index (LVSVI) also significantly worsened in patients developing CTX during cancer treatment. <b>Conclusions:</b> F-SENC CMR provided a reliable and accurate assessment of myocardial function during anthracycline-based chemotherapy, and demonstrated accurate early detection of CTX. In addition, MyoHealth allows for the robust identification of patients at risk for CTX prior to treatment with higher accuracy than LVEF. |
| format | Article |
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| institution | Kabale University |
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| language | English |
| publishDate | 2025-08-01 |
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| series | Diagnostics |
| spelling | doaj-art-767868ae58c841a69fc69f6d1353ea5b2025-08-20T04:00:50ZengMDPI AGDiagnostics2075-44182025-08-011515194810.3390/diagnostics15151948Myocardial Strain Measurements Obtained with Fast-Strain-Encoded Cardiac Magnetic Resonance for the Risk Prediction and Early Detection of Chemotherapy-Related Cardiotoxicity Compared to Left Ventricular Ejection FractionDaniel Lenihan0James Whayne1Farouk Osman2Rafael Rivero3Moritz Montenbruck4Arne Kristian Schwarz5Sebastian Kelle6Pia Wülfing7Susan Dent8Florian Andre9Norbert Frey10Grigorios Korosoglou11Henning Steen12Cardio-Oncology Center of Excellence, Saint Francis Healthcare, Cape Girardeau, MO 63703, USAMyocardial Solutions Incorporated, Morrisville, NC 27599, USAMyocardial Solutions Incorporated, Morrisville, NC 27599, USAMyocardial Solutions Incorporated, Morrisville, NC 27599, USADepartment of Cardiac Imaging (MRI), Center for Preventive Medicine, Marienkrankenhaus Hamburg, 22087 Hamburg, GermanyDepartment of Cardiac Imaging (MRI), Center for Preventive Medicine, Marienkrankenhaus Hamburg, 22087 Hamburg, GermanyCardiac Imaging Unit, Deutsches Herzzentrum der Charité, 10117 Berlin, GermanyBreast Center, Jerusalem Hospital, 20357 Hamburg, GermanyUniversity of Rochester, Rochester, NY 14627, USADepartment of Cardiology, Angiology, and Pneumology, Heidelberg University, 69120 Heidelberg, GermanyDepartment of Cardiology, Angiology, and Pneumology, Heidelberg University, 69120 Heidelberg, GermanyGRN Academic Teaching Hospital Weinheim, 69469 Weinheim, GermanyCardiac Imaging, Medneo GmbH Hospital & Health Care, 10117 Berlin, Germany<b>Background:</b> Breast and hematological cancer treatments, especially with anthracyclines, have been shown to be associated with an increased risk of cardiotoxicity (CTX). An accurate prediction of cardiotoxicity risk and early detection of myocardial injury may allow for effective cardioprotection to be instituted and tailored to reverse cardiac dysfunction and prevent the discontinuation of essential cancer treatments. <b>Objectives:</b> The PRoactive Evaluation of Function to Evade Cardio Toxicity (PREFECT) study sought to evaluate the ability of fast-strain-encoded (F-SENC) cardiac magnetic resonance imaging (CMR) and 2D echocardiography (2D Echo) to stratify patients at risk of CTX prior to initiating cancer treatment, detect early signs of cardiac dysfunction, including subclinical CTX (sub-CTX) and CTX, and monitor for recovery (REC) during cardioprotective therapy. <b>Methods:</b> Fifty-nine patients with breast cancer or lymphoma were prospectively monitored for CTX with F-SENC CMR and 2D Echo over at least 1 year for evidence of cardiac dysfunction during anthracycline based chemotherapy. F-SENC CMR also monitored myocardial deformation in 37 left ventricular (LV) segments to obtain a MyoHealth risk score based on both longitudinal and circumferential strain. Sub-CTX and CTX were classified based on pre-specified cardiotoxicity definitions. <b>Results:</b> CTX was observed in 9/59 (15%) and sub-CTX in 24/59 (41%) patients undergoing chemotherapy. F-SENC CMR parameters at baseline predicted CTX with a lower LVEF (57 ± 5% vs. 61 ± 5% for all, <i>p</i> = 0.05), as well as a lower MyoHealth (70 ± 9 vs. 79 ± 11 for all, <i>p</i> = 0.004) and a worse global circumferential strain (GCS) (−18 ± 1 vs. −20 ± 1 for all, <i>p</i> < 0.001). Pre-chemotherapy MyoHealth had a higher accuracy in predicting the development of CTX compared to CMR LVEF and 2D Echo LVEF (AUC = 0.85, 0.69, and 0.57, respectively). The 2D Echo parameters on baseline imaging did not stratify CTX risk. F-SENC CMR obtained good or excellent images in 320/322 (99.4%) scans. During cancer treatment, MyoHealth had a high accuracy of detecting sub-CTX or CTX (AUC = 0.950), and the highest log likelihood ratio (indicating a higher probability of detecting CTX) followed by F-SENC GLS and F-SENC GCS. CMR LVEF and CMR LV stroke volume index (LVSVI) also significantly worsened in patients developing CTX during cancer treatment. <b>Conclusions:</b> F-SENC CMR provided a reliable and accurate assessment of myocardial function during anthracycline-based chemotherapy, and demonstrated accurate early detection of CTX. In addition, MyoHealth allows for the robust identification of patients at risk for CTX prior to treatment with higher accuracy than LVEF.https://www.mdpi.com/2075-4418/15/15/1948cardiotoxicitycancer chemotherapyventricular straincardiac magnetic resonance imagingejection fraction |
| spellingShingle | Daniel Lenihan James Whayne Farouk Osman Rafael Rivero Moritz Montenbruck Arne Kristian Schwarz Sebastian Kelle Pia Wülfing Susan Dent Florian Andre Norbert Frey Grigorios Korosoglou Henning Steen Myocardial Strain Measurements Obtained with Fast-Strain-Encoded Cardiac Magnetic Resonance for the Risk Prediction and Early Detection of Chemotherapy-Related Cardiotoxicity Compared to Left Ventricular Ejection Fraction Diagnostics cardiotoxicity cancer chemotherapy ventricular strain cardiac magnetic resonance imaging ejection fraction |
| title | Myocardial Strain Measurements Obtained with Fast-Strain-Encoded Cardiac Magnetic Resonance for the Risk Prediction and Early Detection of Chemotherapy-Related Cardiotoxicity Compared to Left Ventricular Ejection Fraction |
| title_full | Myocardial Strain Measurements Obtained with Fast-Strain-Encoded Cardiac Magnetic Resonance for the Risk Prediction and Early Detection of Chemotherapy-Related Cardiotoxicity Compared to Left Ventricular Ejection Fraction |
| title_fullStr | Myocardial Strain Measurements Obtained with Fast-Strain-Encoded Cardiac Magnetic Resonance for the Risk Prediction and Early Detection of Chemotherapy-Related Cardiotoxicity Compared to Left Ventricular Ejection Fraction |
| title_full_unstemmed | Myocardial Strain Measurements Obtained with Fast-Strain-Encoded Cardiac Magnetic Resonance for the Risk Prediction and Early Detection of Chemotherapy-Related Cardiotoxicity Compared to Left Ventricular Ejection Fraction |
| title_short | Myocardial Strain Measurements Obtained with Fast-Strain-Encoded Cardiac Magnetic Resonance for the Risk Prediction and Early Detection of Chemotherapy-Related Cardiotoxicity Compared to Left Ventricular Ejection Fraction |
| title_sort | myocardial strain measurements obtained with fast strain encoded cardiac magnetic resonance for the risk prediction and early detection of chemotherapy related cardiotoxicity compared to left ventricular ejection fraction |
| topic | cardiotoxicity cancer chemotherapy ventricular strain cardiac magnetic resonance imaging ejection fraction |
| url | https://www.mdpi.com/2075-4418/15/15/1948 |
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