ABSTRACT

Children with acute lymphoblastic leukemia (ALL) are treated with doxorubicin-based chemotherapy that can lead to cardiotoxicity which is a well-known cause of mortality. This study aims to characterize myocardial subtle changes induced by doxorubicin-related cardiotoxicity. We used the combination of cardiac magnetic resonance (CMR) imaging, cardiopulmonary exercise testing and the CircAdapt model to explore hemodynamics and intraventricular mechanisms at rest and during exercise in 53 childhood ALL survivors. A sensitivity analysis of the CircAdapt model identified the most influencing parameters on the left ventricle volume. ANOVA were performed to explore significant differences between left ventricle stiffness, contractility, and arteriovenous pressure drop, as well as survivors' prognostic risk groups. No significant differences were observed between prognostic risk groups. The left ventricle stiffness and left ventricle contractility were non-significantly higher in survivors receiving cardioprotective agents (94.3 %), compared to those at standard and high prognostic risk (77 % and 86 %, respectively). In both left ventricle stiffness and left ventricle contractility, we observed that survivors receiving cardioprotective agents were close to the nominal value of CircAdapt (healthy reference group value is 100 %). This study allowed to improve our knowledge of potential subtle myocardial changes induced by doxorubicin-related cardiotoxicity in childhood ALL survivors. This study confirms that survivors exposed to a high cumulative dose of doxorubicin during treatments are at potential risk of myocardial changes many years after the end of their cancer, while cardio-protective agents may prevent changes in cardiac mechanical properties.

PMID:37207545 | DOI:10.1016/j.jbiomech.2023.111616

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PubMed articles on: Cardio-Oncology

Editorial: Cardio-oncology: mechanisms and therapeutics

Front Cardiovasc Med. 2023 May 3;10:1198617. doi: 10.3389/fcvm.2023.1198617. eCollection 2023.

NO ABSTRACT

PMID:37206098 | PMC:PMC10190102 | DOI:10.3389/fcvm.2023.1198617

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PubMed articles on: Cardio-Oncology

Review of cardiovascular imaging in the Journal of Nuclear Cardiology 2022: positron emission tomography, computed tomography, and magnetic resonance

J Nucl Cardiol. 2023 May 19. doi: 10.1007/s12350-023-03283-7. Online ahead of print.

ABSTRACT

In 2022, the Journal of Nuclear Cardiology® published many excellent original research articles and editorials focusing on imaging in patients with cardiovascular disease. In this review of 2022, we summarize a selection of articles to provide a concise recap of major advancements in the field. In the first part of this 2-part series, we addressed publications pertaining to single-photon emission computed tomography. In this second part, we focus on positron emission tomography, cardiac computed tomography, and cardiac magnetic resonance. We specifically review advances in imaging of non-ischemic cardiomyopathy, cardio-oncology, infectious disease cardiac manifestations, atrial fibrillation, detection and prognostication of atherosclerosis, and technical improvements in the field. We hope that this review will be useful to readers as a reminder to articles they have seen during the year as well as ones they have missed.

PMID:37204688 | DOI:10.1007/s12350-023-03283-7

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PubMed articles on: Cardio-Oncology

Quantitative assessment of radiotherapy-induced myocardial damage using MRI: a systematic review

Cardiooncology. 2023 May 18;9(1):24. doi: 10.1186/s40959-023-00175-0.

ABSTRACT

PURPOSE: To determine the role of magnetic resonance imaging (MRI)-based metrics to quantify myocardial toxicity following radiotherapy (RT) in human subjects through review of current literature.

METHODS: Twenty-one MRI studies published between 2011-2022 were identified from available databases. Patients received chest irradiation with/without other treatments for various malignancies including breast, lung, esophageal cancer, Hodgkin's, and non-Hodgkin's lymphoma. In 11 longitudinal studies, the sample size, mean heart dose, and follow-up times ranged from 10-81 patients, 2.0-13.9 Gy, and 0-24 months after RT (in addition to a pre-RT assessment), respectively. In 10 cross-sectional studies, the sample size, mean heart dose, and follow-up times ranged from 5-80 patients, 2.1-22.9 Gy, and 2-24 years from RT completion, respectively. Global metrics of left ventricle ejection fraction (LVEF) and mass/dimensions of cardiac chambers were recorded, along with global/regional values of T1/T2 signal, extracellular volume (ECV), late gadolinium enhancement (LGE), and circumferential/radial/longitudinal strain.

RESULTS: LVEF tended to decline at >20 years follow-up and in patients treated with older RT techniques. Changes in global strain were observed after shorter follow-up (13±2 months) for concurrent chemoradiotherapy. In concurrent treatments with longer follow-up (8.3 years), increases in left ventricle (LV) mass index were correlated with LV mean dose. In pediatric patients, increases in LV diastolic volume were correlated with heart/LV dose at 2 years post-RT. Regional changes were observed earlier post-RT. Dose-dependent responses were reported for several parameters, including: increased T1 signal in high-dose regions, a 0.136% increase of ECV per Gy, progressive increase of LGE with increasing dose at regions receiving >30 Gy, and correlation between increases in LV scarring volume and LV mean/V10/V25 Gy dose.

CONCLUSION: Global metrics only detected changes over longer follow-up, in older RT techniques, in concurrent treatments, and in pediatric patients. In contrast, regional measurements detected myocardial damage at shorter follow-up and in RT treatments without concurrent treatment and had greater potential for dose-dependent response. The early detection of regional changes suggests the importance of regional quantification of RT-induced myocardial toxicity at early stages, before damage becomes irreversible. Further works with homogeneous cohorts are required to examine this matter.

PMID:37202766 | PMC:PMC10193692 | DOI:10.1186/s40959-023-00175-0

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PubMed articles on: Cardio-Oncology

An ensemble classifier method based on teaching-learning-based optimization for breast cancer diagnosis

J Cancer Res Clin Oncol. 2023 May 19. doi: 10.1007/s00432-023-04861-5. Online ahead of print.

ABSTRACT

INTRODUCTION: Epidemiological studies show that breast cancer is the most common cancer in women in the world. Breast cancer treatment can be very effective, especially when the disease is detected in the early stages. The goal can be achieved by using large-scale breast cancer data with the machine learning models METHODS: This paper proposes a new intelligent approach using an optimized ensemble classifier for breast cancer diagnosis. The classification is done by proposing a new intelligent Group Method of Data Handling (GMDH) neural network-based ensemble classifier. This method improves the performance of the machine learning technique by using a Teaching-Learning-Based Optimization (TLBO) algorithm to optimize the hyperparameters of the classifier. Meanwhile, we use TLBO as an evolutionary method to address the problem of appropriate feature selection in breast cancer data.

RESULTS: The simulation results show that the proposed method has a better accuracy between 7 and 26% compared to the best results of the existing equivalent algorithms.

CONCLUSION: According to the obtained results, we suggest the proposed algorithm as an intelligent medical assistant system for breast cancer diagnosis.

PMID:37202580 | DOI:10.1007/s00432-023-04861-5

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PubMed articles on: Cardio-Oncology

Emerging role of PET/MR in the diagnosis and characterization of cardiotoxicity?

Int J Cardiol. 2023 May 16:S0167-5273(23)00716-7. doi: 10.1016/j.ijcard.2023.05.022. Online ahead of print.

ABSTRACT

In cardiotoxicity, PET/MR affords an accurate evaluation of cardiovascular morphology, function, and also multi-parametric tissue characterization. A composite of several cardiac imaging parameters provided by the PET/MR scanner is likely to outperform a single parameter or imaging modality in the assessment and prediction of the severity and progression of cardiotoxicity but needing clinical investigations. Of particular interest, a heterogeneity map of single PET and CMR parameters could be perfectly correlated with the PET/MR scanner likely emerging as a promising marker of cardiotoxicity to monitor treatment response. While such functional and structural multiparametric imaging approach with cardiac PET/MR in the assessment and characterization of cardiotoxicity holds much promise, its validity and value in cancer patients treated with chemotherapy and/or radiation still needs to be assessed. The multi-parametric imaging approach with PET/MR, however, is likely to set new standards to develop predictive constellations of parameters for the severity and potential progression of cardiotoxicity that should afford timely and individualized treatment intervention to ascertain myocardial recovery and improved clinical outcome in these high-risk patients.

PMID:37201611 | DOI:10.1016/j.ijcard.2023.05.022

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PubMed articles on: Cardio-Oncology

Cardiac Myxomas As Chameleons: A Scoping Review of Their Paraneoplastic Presentations

Cureus. 2023 Apr 14;15(4):e37558. doi: 10.7759/cureus.37558. eCollection 2023 Apr.