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Accuracy of cardiotoxicity detection with fast strain-encoded CMR vs echocardiography

Session Poster session 2

Speaker Moritz Montenbruck

Event : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance
  • Session type : Poster Session

Authors : H Steen (Hamburg,DE), M Montenbruck (Hamburg,DE), S Esch (Hamburg,DE), A Schwarz (Hamburg,DE), S Kelle (Berlin,DE), P Wuelfing (Hamburg,DE), F Andre (Heidelberg,DE), G Korosoglou (Weinheim,DE)

Authors:
H Steen1 , M Montenbruck1 , S Esch1 , A Schwarz1 , S Kelle2 , P Wuelfing3 , F Andre4 , G Korosoglou5 , 1Marien Hospital - Hamburg - Germany , 2Charite University Hospital - Berlin - Germany , 3Mammazentrum am Krankenhaus Jerusalem - Hamburg - Germany , 4University Hospital of Heidelberg - Heidelberg - Germany , 5GRN-Klinik Weinheim - Weinheim - Germany ,

Citation:
European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii322

Background:

Left ventricular ejection fraction (LVEF) is an accepted metric for identifying cardiotoxicity in patients undergoing cancer therapy. Unfortunately, LVEF identifies reduced systemic cardiac function in symptomatic patients once the heart is unable to compensate for regional dysfunction. More sensitive metrics are needed to detect subclinical dysfunction before cardiac remodeling. Fast-SENC segmental intramyocardial strain (fSENC) is a unique cardiac magnetic resonance imaging (CMR) modality that measures myocardial contraction in 1 heartbeat per image plane. This prospective study compares fSENC, conventional CMR-LV-EF and transthoracic echocardiography (Echo) LVEF und GLS in patients undergoing chemotherapy.

Methods:

This single center, prospective Prefect Study was used to evaluate the cardiotoxicity in Breast Cancer and Lymphoma patients (NCT03543228). CMR with fSENC pulse sequences were acquired with a 1.5T MRI and processed with the MyoStrain software to quantify intramyocardial strain. Three short axis scans (basal/midventricular/apical) measured strain in 16 longitudinal segments while three long axis scans (2-chamber/3-chamber/4-chamber) measured 21 circumferential segments. CMR exams were performed before chemotherapy, during and after anthracycline therapy, after taxane therapy, at 1 year follow-up and anytime warranting evaluation of cardiac function.

Results:

Fifty (50) patients, 43 female, were enrolled. To date, 187 MRI exams and 146 Echos have been performed (31 echos not performed, 10 have not been analyzed).  Patients had an average (± stdev) age of 52 (15) yrs, BMI of 26 (6) kg/m2; 76% were treated for breast cancer, 24% for Lymphoma. Follow-up MRIs required 11.6 (2.2) min total exam time. Of the exams performed, 96% of fSENC scans had 6/6 good image sequences (99% had 5/6 good planes) while only 27% of Echos had 3/3 adequate planes (44% had 2/3 adequate planes). fSENC detected cardiotoxicity in patients ultimately receiving cardioprotective therapy by demonstrating a 27.4% worsening of regional strain (calculated as % of normal myocardium) compared to a 6.3% worsening of CMR LVEF. In contrast a 1.1% improvement in Echo LVEF, and a 2.0% improvement in Echo GLS.

Figure 1 shows the relationship between CMR LVEF in the y-axis versus the amount of normal myocardium (strain < -17%) with fSENC in the x-axis. A polynomial fit curve showed a nonlinear decline in CMR LVEF after regional dysfunction exceeded 40% of total myocardium (r = 0.60) while Echo GLS did not show any correlation to CMR LVEF.

Conclusion:

fSENC detects subclinical dysfunction due to cardiotoxic response of chemotherapy before changes in CMR-LVEF or Echo-GLS. The ability to detect subclinical effects of diseases and pharmacological cardiotoxicity enables proactive prescription of cardioprotective agents to avoid tissue remodeling that is associated with systemic cardiac dysfunction culminating in worsening of global measures such as LVEF.

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