Abstract
BackgroundCardiovascular disease is second only to cancer recurrence as a determinant of lifespan in cancer survivors, and cancer therapy-related cardiac dysfunction is a clinically important risk factor. We aim to investigate the use of cardiac magnetic resonance imaging (MRI) to evaluate early tissue changes and perform functional assessment of chemo- and radiation-induced cardiotoxicity and to identify MRI prognostic indicators of cardiotoxicity in breast cancer patients.MethodsA 3-min cardiac imaging protocol will be added to the breast MRI examination to diagnose cardiotoxicity in breast cancer patients. Standardized MRI-based evaluation of breast cancer and the left ventricular myocardium will be performed at baseline and at 3, 6, and 12 months and 2 years or more after cancer treatment. We will analyze both ventricular volume and ejection fraction (EF), strain of left ventricle (LV), native T1, extracellular volume fraction (ECV), and T2 values acquired in the mid LV.DiscussionThe primary result of this study will be the comparison of the prognostic value of MRI parameters (native T1, ECV, both ventricular systolic function and LV strain) for cardiotoxicity. The endpoint is defined as the occurrence of a major adverse cardiac event (MACE). The secondary outcome will be an assessment of the temporal relationships between contractile dysfunction and microstructural injury over 4 years using MRI. This study will assess the usefulness of quantitative MRI to diagnose cardiotoxicity and will clarify the temporal relationships between contractile dysfunction and microstructural injury of the LV myocardium using MRI during breast cancer treatment.Trial registrationThe protocol was registered at clinicaltrials.gov (Clinical trial no. NCT03301389) on October 4, 2017.
Highlights
Cardiovascular disease is second only to cancer recurrence as a determinant of lifespan in cancer survivors, and cancer therapy-related cardiac dysfunction is a clinically important risk factor
To achieve the goal of the study, cardiac magnetic resonance imaging (MRI) protocols for cardiotoxicity diagnosis will be applied to breast cancer patients who have received or are planning to receive chemotherapy
Primary and secondary objectives The primary objective of this study is to investigate and compare the prognostic value of cardiac MRI parameters (native and postcontrast T1 mapping, extracellular volume fraction (ECV), right ventricular (RV), left ventricle (LV) systolic function, and global longitudinal strain of LV) for cardiotoxicity
Summary
Cardiovascular disease is second only to cancer recurrence as a determinant of lifespan in cancer survivors, and cancer therapy-related cardiac dysfunction is a clinically important risk factor. Earlier diagnosis and improved systemic therapies, including targeted therapies, lead to longer life expectancy after cancer treatment [2,3,4]. Treatment-related comorbidities have become an important issue for long-term cancer survivors [5]. Cancer therapy-related cardiac dysfunction (CTRCD) is the second leading cause of death in cancer survivors after cancer-related mortality [1, 5, 6]. CTRCD is an important problem in the context of breast cancer because the incidence in young women is increasing while the prognosis is improving due to the development of various new treatments. Various breast cancer treatments lead to cardiac dysfunction
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