CMR assessment of myocardial mechanics and tissue characterization in patients treated with Anthracycline chemotherapy for acute myeloid leukaemia

Abstract

Background Anthracycline-associated cardiomyopathy is a progressive, dose-dependent complication of Anthracycline chemotherapy. The period between Anthracycline therapy and onset of overt heart failure is often years, even decades, and as such Anthracyclines appear to initiate a myocardial injury that remains clinically silent for a substantial period of time. Left ventricular (LV) ejection fraction (EF) is often preserved during this latent period. A more sensitive marker of Anthracycline-associated myocardial injury would allow earlier diagnosis, hence potentially earlier initiation of cardioprotective therapy, and better prognostication. We assessed the relationship between cumulative Anthracycline dose and myocardial function (global and regional) and myocardial fibrosis (focal and diffuse) in patients who had previously received Anthracycline chemotherapy for acute myeloid leukaemia (AML) with normal or near normal LV EF. Methods 15 patients with a prior history of AML underwent 1.5T CMR (Avanto, Siemens). LV volumetric analysis was performed on SSFP images. Mitral inflow was assessed using phase-contrast velocity mapping. Spatial modulation of magnetization was performed on a mid-ventricular short-axis slice in order to assess peak systolic circumferential strain (ecc). T1 mapping was performed pre- and 10-minutes post 0.15mmol/kg gadoliniumDTPA using a modified look locker inversion recovery