Department of Cardiology, IRCCS - Azienda Ospedaliero-Universitaria di Bologna - Policlinico di S. Orsola, Bologna, Italy.
Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Bologna, Italy.
J Nucl Cardiol. 2023 Oct;30(5):2104-2111. doi: 10.1007/s12350-023-03202-w. Epub 2023 Feb 28.
Cancer therapy-induced cardiotoxicity is an emerging clinical and healthcare issue. Myocardial dysfunction and heart failure are mostly responsible for increased cardiovascular mortality in cancer disease survivors. Several imaging surveillance techniques have been proposed for early diagnosis of cancer therapy-induced cardiac dysfunction. Our aim was to provide an update of radionuclide angiography applications in this field. Radionuclide angiography is widely used to assess left ventricular ejection fraction (LVEF) throughout cancer treatment, especially in patients with limited acoustic window. Additional prognostic data may be provided by phase analysis and diastolic function evaluation. Low LVEF and high approximate entropy at baseline seem to be predictors for cancer therapy-induced cardiac dysfunction. A decrease in peak filling rate and/or an increase in time to peak filling rate may be observed in patients undergoing anthracycline and/or trastuzumab administration. Diastolic function impairment may precede or not LVEF decrease. In conclusion, recent studies have provided novel insights into the possible role of radionuclide angiography in the early detection of cancer therapy cardiotoxicity. While interpreting the results of a radionuclide angiography examination, an integrated approach combining the evaluation of LVEF, LV diastolic function, and phase analysis may be useful to improve risk stratification of cancer patients treated with cardiotoxic agents.
癌症治疗相关的心脏毒性是一个新出现的临床和医疗保健问题。心肌功能障碍和心力衰竭是癌症幸存者心血管死亡率增加的主要原因。已经提出了几种影像学监测技术用于早期诊断癌症治疗相关的心脏功能障碍。我们的目的是提供放射性核素血管造影在这一领域的应用的最新进展。放射性核素血管造影广泛用于评估整个癌症治疗过程中的左心室射血分数（LVEF），特别是在声学窗口有限的患者中。相位分析和舒张功能评估可提供额外的预后数据。低 LVEF 和高基线近似熵似乎是癌症治疗相关心脏毒性的预测因子。在接受蒽环类药物和/或曲妥珠单抗治疗的患者中，可观察到峰值充盈率降低和/或峰值充盈时间增加。舒张功能障碍可能先于或不伴有 LVEF 降低。总之，最近的研究为放射性核素血管造影在早期检测癌症治疗相关性心脏毒性中的可能作用提供了新的见解。在解释放射性核素血管造影检查结果时，结合 LVEF、LV 舒张功能和相位分析评估的综合方法可能有助于改善接受心脏毒性药物治疗的癌症患者的风险分层。
