Abstract 11544: Prognostic Risk Stratification of Cardiac Metastasis via Quantitative Perfusion Cardiac Magnetic Resonance Imaging

Abstract

Introduction: Cardiac magnetic resonance (CMR) is widely used to assess cardiac masses, including cardiac metastases (C MET ). Perfusion CMR can quantify magnitude of tumor vascularity; prognostic relevance of lesion perfusion among patients (pts) with C MET is unknown. Methods: The population comprised adult cancer pts with C MET and controls matched for cancer type/stage. Late gadolinium enhancement (LGE) CMR was the reference for C MET . Perfusion CMR quantified vascularity within lesions, including contrast enhancement (CER: maximum vs. baseline) and uptake (CUR [slope] ratios during gadolinium infusion (0.1mmol/kg). Follow-up was performed for mortality. Results: 155 C MET pts (59 ± 15yo, 56% male) and cancer matched controls underwent CMR, including a range of primary cancers (sarcoma 22%, GU 17%, GI & lung 12%). Anti-cancer treatment, cardiac risk factors and LVEF were similar between groups (p=NS). In relation to LGE-CMR, perfusion yielded good performance to distinguish C MET (AUC 0.57-0.97; p < 0.001). During follow-up, C MET pts tended to have higher aggregate 1 year mortality vs. controls (56% vs. 46%; p=0.09); median time to death was 6.8 (2.5, 17.1) months post-CMR. Pts with C MET on perfusion CMR had higher mortality risk than controls (HR 1.41 [1.04-1.92], p=0.03), paralleling LGE-CMR (HR 1.52 [CI 1.14-2.02], p=0.004). C MET mortality increased stepwise with impaired perfusion (Figure A) and was highest among pts in the bottom (vs. top) CER tertile, corresponding to decreased tumor vascularity. Among cancer matched subgroups, pts with C MET in the bottom CER tertile had higher mortality than controls (p < 0.001); prognosis was equivalent to controls (p=NS) among pts with lesions in the highest two CER tertiles (Figure B). Conclusions: Perfusion CMR identifies CMET based on vascularity and stratifies prognosis: Among cancer pts with CMET on LGE, mortality increases in proportion to magnitude of decreased tumor vascularity on perfusion CMR.