Abstract
BackgroundAccurate diagnostic tools to identify patients at risk of cancer therapy-related cardiac dysfunction (CTRCD) are critical. For patients undergoing cardiotoxic cancer therapy, ejection fraction assessment using radionuclide ventriculography (RNVG) is commonly used for serial assessment of left ventricular (LV) function. MethodsIn this retrospective study, approximate entropy (ApEn), synchrony, entropy, and standard deviation from the phase histogram (phase SD) were investigated as potential early markers of LV dysfunction to predict CTRCD. These phase parameters were calculated from the baseline RNVG phase image for 177 breast cancer patients before commencing cardiotoxic therapy. ResultsOf the 177 patients, 11 had a decline in left ventricular ejection fraction (LVEF) of over 10% to an LVEF below 50% after treatment had commenced. This patient group had a significantly higher ApEn at baseline to those who maintained a normal LVEF throughout treatment. Of the parameters investigated, ApEn was superior for predicting the risk of CTRCD. Combining ApEn with the baseline LVEF further improved the discrimination between the groups. ConclusionsThe results suggest that RNVG phase analysis using approximate entropy may aid in the detection of sub-clinical LV contraction abnormalities, not detectable by baseline LVEF measurement, predicting a subsequent decline in LVEF.
Highlights
Survival from breast cancer has improved substantially over the last 20 to 30 years due to earlier diagnosis and advances in treatment with adjuvant radiotherapy and chemotherapy
Of the 177 patients, 11 had a decline in left ventricular ejection fraction (LVEF) of over 10% to an LVEF below 50% after treatment had commenced
The results suggest that radionuclide ventriculography (RNVG) phase analysis using approximate entropy may aid in the detection of sub-clinical LV contraction abnormalities, not detectable by baseline LVEF measurement, predicting a subsequent decline in LVEF. (J Nucl Cardiol 2020)
Summary
Survival from breast cancer has improved substantially over the last 20 to 30 years due to earlier diagnosis and advances in treatment with adjuvant radiotherapy and chemotherapy. Radiotherapy and anthracycline/trastuzumab-based chemotherapy regimens have been associated with increased risk of cardiovascular disease.[3] Anthracycline-based regimens are associated with the dosedependent risk of Type 1 cardiotoxicity and heart failure, while trastuzumab is generally associated with reversible Type 2 cardiotoxicity. Permanent cardiac dysfunction can occur with both Type 1 and 2 cardiotoxicity, despite intervention.[4] The risk of cancer therapy-related cardiac dysfunction (CTRCD) increases significantly when trastuzumab is combined with anthracyclines.[5] Cardiac monitoring is required for patients receiving anthracycline/trastuzumab-based treatments, and currently, this relies on the serial assessment of left ventricular ejection fraction (LVEF). The European Society of Cardiology (ESC) guidelines consider a 10% point decrease of LVEF to below the lower limit of normal (\ 50%) to be an indicator of cardiotoxicity and recommend treatment is altered or stopped to prevent further left ventricular (LV) dysfunction or the development of symptomatic heart failure.[6]. For patients undergoing cardiotoxic cancer therapy, ejection fraction assessment using radionuclide ventriculography (RNVG) is commonly used for serial assessment of left ventricular (LV) function
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