In order to bring you the best possible user experience, this site uses Javascript. If you are seeing this message, it is likely that the Javascript option in your browser is disabled. For optimal viewing of this site, please ensure that Javascript is enabled for your browser.

The free consultation period for this content is over.

It is now only available year-round to ESC Professional Members, Fellows of the ESC, and Young combined Members

CMR Fast-SENC intramyocardial LV & RV segmental strain detects cardiotoxicity during oncology treatment and impact of cardioprotection therapy before echocardiography

Session Cardio-Oncology: insights from basic , clinical, data science

Speaker Moritz Montenbruck

Event : ESC Congress 2019

  • Topic : heart failure
  • Sub-topic : Cardiotoxicity of Drugs and Other Therapies
  • Session type : Moderated Posters

Authors : H Steen (Hamburg,DE), M Montenbruck (Hamburg,DE), P Wuelfing (Hamburg,DE), S Esch (Hamburg,DE), AK Schwarz (Hamburg,DE), BLAZ Gersak (Ljubljana,SI), S Kelle (Berlin,DE), G Korosoglou (Weinheim,DE), D Lenihan (St Louis,US)

Authors:
H Steen1 , M Montenbruck1 , P Wuelfing2 , S Esch3 , AK Schwarz3 , BLAZ Gersak4 , S Kelle5 , G Korosoglou6 , D Lenihan7 , 1Marienhospital, Cardiac imaging, cardio-oncology - Hamburg - Germany , 2Mammazentrum am Krankenhaus Jerusalem - Hamburg - Germany , 3Marien Hospital - Hamburg - Germany , 4University of Ljubljana - Ljubljana - Slovenia , 5Charite University Hospital - Berlin - Germany , 6GRN-Klinik Weinheim - Weinheim - Germany , 7Washington University School of Medicine - St Louis - United States of America ,

Citation:

Background:
The incidence of cardiotoxicity during cancer therapy is underestimated due to limitations of current diagnostic tests. Current biomarkers (BNP, NT-pro-BNP, hs-Troponin, etc.) and imaging calculations (e.g. echocardiography) such as left ventricular ejection fraction (LVEF) are currently included in the guidelines to designate cardiotoxicity during cancer therapy. Unfortunately, these diagnostics identify systemic damage in symptomatic patients after the heart is unable to compensate for regional dysfunction. Fast-SENC segmental intramyocardial strain (fSENC) is a unique cardiac magnetic resonance imaging (CMR) test that regionally detects subclinical intramyocardial dysfunction in 1 heartbeat.

Methods:
This single center, prospective Prefect Study was used to evaluate cardiotoxicity and the impact of cardioprotective therapy in Breast Cancer and Lymphoma patients (NCT03543228). fSENC was acquired with a 1.5T MRI and processed with the software to quantify intramyocardial strain.  Segmental strain was measured in three short axis scans (basal, midventricular, apical) with 16 LV / 6 RV longitudinal segments & three long axis scans (2-, 3-, 4-chamber) with 21 LV / 5 RV circumferential segments. fSENC CMR was performed before chemotherapy, during and after anthracycline/taxane therapy, at 1 year follow-up, and as needed in between designated follow-up periods. Cardioprotective therapy was offered to patients meeting the definition of cardiotoxicity by the ESC Guidelines on Cardiotoxicity and/or ESMO Clinical Practice Guidelines or those observing a substantial decline in cardiac function.

Results:
Two hundred eight (208) CMRs were performed in fifty-two (52) patients (44 female).  Patients had an average (± stdev) age of 53 (15) yrs, BMI of 26 (5) kg/m2; 77% had breast cancer, 23% had Lymphoma.  fSENC CMRs required 11 (2) min total exam time.  The % of normal fSENC (segmental stain < -17%) with a threshold of 65% showed a sensitivity of 87% and specificity of 89% in detecting cardiotoxicity while echocardiography GLS with a threshold of -17% observed a sensitivity of 20% and specificity of 88%.  Figure 1 shows receiver operating characteristic curves for fSENC based on the percent of normal myocardium, and echocardiography global longitudinal strain (GLS) respectively. Global fSENC had substantially lower sensitivity than segmental fSENC despite having higher accuracy than the other global metrics.

Conclusion:
Segmental fSENC intramyocardial strain detects subclinical dysfunction due to cardiotoxic response of chemotherapy before other biomarkers and imaging modalities. The ability to detect the subclinical cardiotoxicity of chemotherapy agents, or other pharmacological agents that cause or worsen heart failure, enables proactive prescription of cardioprotective medications to avoid tissue remodeling that precedes systemic cardiac dysfunction and worsening of global measures such as LVEF and current biomarkers.

Members get more

Join now
  • 1ESC Professional Members – access all resources from general ESC events 
  • 2ESC Association Members (Ivory, Silver, Gold) – access your Association’s resources
  • 3Under 40 or in training - with a Combined Membership, access all resources
Join now

Our sponsors

ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.

logo esc

Our mission: To reduce the burden of cardiovascular disease

Who we are