CMR imaging biosignature of cardiac involvement due to cancer-related treatment by T1 and T2 mapping
CMR imaging biosignature of cardiac involvement due to cancer-related treatment by T1 and T2 mapping
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DOI：
10.1016/j.ijcard.2018.10.023
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发表时间：
2019-01-15
影响因子：
3.5
通讯作者：
Puntmann, Valentina O.
中科院分区：
文献类型：
--
作者：
Haslbauer, Jasmin D.;Lindner, Sarah;Puntmann, Valentina O.
背景：癌症相关治疗与心力衰竭的发展和癌症幸存者的不良结局有关。通过心血管磁共振（CMR）的T1和T2映射可以检测由于癌症相关treatment.Methods：接受癌症相关治疗方案的患者在治疗后3个月内（早期Tx）或>12个月（晚期Tx）接受CMR心脏受累筛查。结果：与年龄/性别匹配的对照组（n=57）相比，患者（n=115，年龄（岁）：中位数（IQR）48（2860），女性，n=60（52%））左心室射血分数（LV-EF）和应变降低，天然T1和T2较高。与晚期Tx组相比，早期Tx组（n=52）具有显著更高的天然T1、T2和肌钙蛋白水平，表明心肌炎症和水肿（p < 0.01）。相反，晚期Tx患者显示天然T1升高，LV收缩末期容积增加，LV-EF和变形降低，NT-proBNP升高，表明心肌纤维化和重塑（p < 0.05）。在一个独立的队列中前瞻性验证了这些结果，这些队列中的患者采用相似的治疗方案（n=25），纵向评估显示早期和晚期心脏受累的CMR成像特征具有高度一致性。天然T1和T2标测在检测和监测癌症相关治疗的心脏受累方面可能是有价值的，分别提供了早期炎症参与（升高的天然T1和T2）和间质纤维化和重塑（升高的天然T1而不是T2）的不同生物特征。我们的研究结果可能提供一种算法，允许识别易感心肌，以潜在地指导心脏保护治疗措施。(c)2018爱思唯尔B. V.保留所有权利。
Background: Cancer-related treatment is associated with development of heart failure and poor outcome in cancer- survivors. T1 and T2 mapping by cardiovascular magnetic resonance (CMR) may detect myocardial injury due to cancer-related treatment.Methods: Patients receiving cancer-related treatment regimes underwent screening of cardiac involvement with CMR, either within 3 months (early Tx) or >12 months (late Tx) post-treatment. T1 and T2 mapping, cardiac function, strain, ischaemia-testing, scar-imaging and serological cardiac biomarkers were obtained.Results: Compared to age/gender matched controls (n=57), patients (n=115, age (yrs): median(IQR) 48(2860), females, n=60(52%) had reduced left ventricular ejection fraction (LV-EF) and strain, and higher native T1 and T2. The early Tx group (n=52) had significantly higher native T1, T2 and troponin levels compared to the late Tx group, indicating myocardial inflammation and oedema (p < 0.01). On the contrary, late Tx patients showed raised native T1, increased LV-end-systolic volumes, reduced LV-EF and deformation, and elevated NT-proBNP, suggesting myocardial fibrosis and remodelling (p < 0.05). Prospective validation of these results in an independent cohort of patients with similar treatment regimens (n=25) and longitudinal assessments revealed high concordance of CMR imaging signatures of early and late cardiac involvement.Conclusions: Native T1 and T2 mapping can be valuable in detecting and monitoring of cardiac involvement with cancer- related treatment, providing distinct biosignatures of early inflammatory involvement (raised native T1 and T2) and interstitial fibrosis and remodelling (raised native T1 but not T2), respectively. Our findings may provide an algorithm allowing to identify susceptible myocardium to potentially guide cardio-protective treatment measures. (c) 2018 Elsevier B.V. All rights reserved.