Cardio-Oncology and Multi-Imaging Modalities

Abstract

Early detection and the rise of targeted cancer treatment have led to increased overall survival and decreased mortality among cancer patients. As the cancer survivor population ages, there is an increased risk for cardiovascular disease due to pre-existing comorbidities, deconditioning during therapy, or the natural progression of aging. Furthermore, with emerging oncologic therapies, there is an increased recognition of their potential cardiovascular toxicities. Indeed, heart disease is the leading cause of death in cancer survivors, which may reflect upon both the success of novel oncologic therapies and their potential cardiovascular toxicities. This recognition has driven the development of cardio-oncology, a multi-disciplinary field that involves collaboration between hematologists, oncologists, and cardiologists to screen, prevent, and manage cardiovascular disease in cancer patients and cancer survivors. The field focuses on early cardiovascular detection and prevention for these patients before, during, and after their oncologic treatment. As oncologic therapies evolve and our knowledge of short- and long-term adverse cardiovascular effects grows, it is critical for physicians to identify those at risk for increased morbidity and mortality, while also balancing the importance of their oncologic treatment plan. Multimodality cardiac imaging is the crux of the diagnosis and surveillance of these patients within cardio-oncology, and includes echocardiography, nuclear, computed tomography (CT), and cardiac magnetic resonance (CMR). Cardiac imaging is essential to establish the baseline function and assess various cardiotoxicities, including left ventricular dysfunction, heart failure, atherosclerosis, vascular injury, and arrhythmias. This review will discuss common oncologic therapies and their cardiotoxic profiles, the cardiac multimodality imaging modalities used in cardio-oncology, and the various approaches for the diagnosis and surveillance of this population.

Keywords: cardio-oncology; multi-modality imaging.

Figure 1

4 Chamber systole (A) and diastole (B) demonstrate apical dilation/ballooning and hypokinesis and basal contraction.

Figure 2

Elevated T1 mapping (A) and edema (B) in the T2 weighted images. (C) Short-axis (black arrow) and (D) four-chamber (white arrow) views reveal interventricular mid-myocardial LGE.

Figure 3

4 Chamber (A) and short-axis (B) phase-sensitive inversion recovery sequences that demonstrate severe circumferential pericardial LGE pericardial edema/inflammation.

Figure 4

Normal coronary arteries’ CPR reconstructions: (A) Left anterior descendant, (B) Left circumflex, (C) Right coronary artery.

Figure 5

Multiplanar reconstruction (A,B) with arrows demonstrating a thrombus in the tip left-atrial appendage. (C) Volume rendering 3D reconstruction of left atrium with separate insertion of the right-superior and -inferior and left-superior and -inferior pulmonary arteries.