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Cardiac MRI for differentiating chemotherapy-induced cardiotoxicity in sarcoma and breast cancer

El-Sayed H Ibrahim

El-Sayed H Ibrahim

Medical College of WisconsinMilwaukee, USA
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Ibrahim, El-Sayed H
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Lubna Chaudhary

Lubna Chaudhary

Medical College of WisconsinMilwaukee, USA
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Chaudhary, Lubna
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Yee-Chung Cheng

Yee-Chung Cheng

Medical College of WisconsinMilwaukee, USA
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Cheng, Yee-Chung
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Antonio Sosa

Antonio Sosa

Medical College of WisconsinMilwaukee, USA
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Sosa, Antonio
, 
Dayeong An

Dayeong An

Northwestern UniversityEvanston, USA
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An, Dayeong
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John Charlson

John Charlson

Medical College of WisconsinMilwaukee, USA
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Charlson, John
  
27 feb 2025
Cardiac MRI for differentiating chemotherapy-induced cardiotoxicity in sarcoma and breast cancer's Cover Image
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Categoria dell'articolo: research article
Pubblicato online: 27 feb 2025
Pagine: 79 - 90
Ricevuto: 12 ago 2024
Accettato: 21 nov 2024
DOI: https://doi.org/10.2478/raon-2025-0012
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© 2025 El-Sayed H Ibrahim et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

FIGURE 1.

MRI tissue characterization maps in (A) sarcoma and (B) breast cancer. The figure shows myocardial T1, extracellular volume (ECV), and T2 maps. Note changes in the maps between sarcoma and breast cancer patients as well as between different study timepoints (baseline, posttreatment, 6-months follow-up).
MRI tissue characterization maps in (A) sarcoma and (B) breast cancer. The figure shows myocardial T1, extracellular volume (ECV), and T2 maps. Note changes in the maps between sarcoma and breast cancer patients as well as between different study timepoints (baseline, posttreatment, 6-months follow-up).

FIGURE 2.

MRI strain curves in (A) sarcoma and (B) breast cancer patients. The figure shows circumferential (GCS), radial (GRS), and longitudinal (GLS) strain curves in both patient groups at different study timepoints. Myocardial strain for each case is represented by 6 segmental strain curves, color-coded based on the regional location as shown by the lower-right 6-segment illustration based on AHA standard LV model. Note changes in the strain curves between sarcoma and breast cancer patients as well as between different study timepoints (baseline, post-treatment, 6-months follow-up). Note also differences in segmental strain values within the same slice.
MRI strain curves in (A) sarcoma and (B) breast cancer patients. The figure shows circumferential (GCS), radial (GRS), and longitudinal (GLS) strain curves in both patient groups at different study timepoints. Myocardial strain for each case is represented by 6 segmental strain curves, color-coded based on the regional location as shown by the lower-right 6-segment illustration based on AHA standard LV model. Note changes in the strain curves between sarcoma and breast cancer patients as well as between different study timepoints (baseline, post-treatment, 6-months follow-up). Note also differences in segmental strain values within the same slice.

FIGURE 3.

Global longitudinal (GLS), circumferential (GCS), and radial (GRS) strains at baseline, post-treatment, and 6-months follow-up in (A) sarcoma and (B) breast cancer patients. Note different patterns of change in strain between the two patient groups. In general, GRS is lower than GCS, which is lower than GLS. GCS and GLS are represented by absolute value (original values are negative) for clearer presentation along with positive GRS.
Global longitudinal (GLS), circumferential (GCS), and radial (GRS) strains at baseline, post-treatment, and 6-months follow-up in (A) sarcoma and (B) breast cancer patients. Note different patterns of change in strain between the two patient groups. In general, GRS is lower than GCS, which is lower than GLS. GCS and GLS are represented by absolute value (original values are negative) for clearer presentation along with positive GRS.

FIGURE 4.

Global cardiac function parameters: (A) left ventricular ejection fraction (RVEF), (B) right ventricular ejection fraction (RVEF), and (C) LV mass at baseline, posttreatment, and 6-months follow-up timepoints in sarcoma and breast cancer patients. LVEF is normal in both groups at all timepoints. RV EF is lower in breast cancer compared to sarcoma. LV mass shows continuous increase with time in sarcoma.
Global cardiac function parameters: (A) left ventricular ejection fraction (RVEF), (B) right ventricular ejection fraction (RVEF), and (C) LV mass at baseline, posttreatment, and 6-months follow-up timepoints in sarcoma and breast cancer patients. LVEF is normal in both groups at all timepoints. RV EF is lower in breast cancer compared to sarcoma. LV mass shows continuous increase with time in sarcoma.

FIGURE 5.

Myocardial (A) T1, (B) T2, and (C) extracellular volume (ECV) measurements in sarcoma and breast cancer groups at different study timepoints. All parameters show continuous increase with time in breast cancer. Sarcoma shows different patterns of change, e.g., continuous decrease of ECV with time. Post-treatment and 6-months follow-up T1 values in sarcoma are lower than those in in breast cancer. T2 shows minimal increase with time in sarcoma.
Myocardial (A) T1, (B) T2, and (C) extracellular volume (ECV) measurements in sarcoma and breast cancer groups at different study timepoints. All parameters show continuous increase with time in breast cancer. Sarcoma shows different patterns of change, e.g., continuous decrease of ECV with time. Post-treatment and 6-months follow-up T1 values in sarcoma are lower than those in in breast cancer. T2 shows minimal increase with time in sarcoma.

FIGURE 6.

Changes in serum biomarkers at different timepoints in (A) sarcoma and (B) breast cancer. CRP = C-reactive protein (μg/mL); Gal3 = Galectin 3 (ng/mL); IL-6 = Interleukin 6 (fluorescence intensity units); NT-proBNP = N-terminal pro b-type natriuretic peptide (pg/mL); TNFa = tumor necrosis factor alpha (pg/mL); TnI = cardiac troponin I (florescence intensity units), TnT = cardiac troponin T (pg/mL). The figure shows different patterns of change in the biomarkers between sarcoma and breast cancer. Not all biomarkers increased post-treatment. Different parameters reflect different aspects of cardiac injury.
Changes in serum biomarkers at different timepoints in (A) sarcoma and (B) breast cancer. CRP = C-reactive protein (μg/mL); Gal3 = Galectin 3 (ng/mL); IL-6 = Interleukin 6 (fluorescence intensity units); NT-proBNP = N-terminal pro b-type natriuretic peptide (pg/mL); TNFa = tumor necrosis factor alpha (pg/mL); TnI = cardiac troponin I (florescence intensity units), TnT = cardiac troponin T (pg/mL). The figure shows different patterns of change in the biomarkers between sarcoma and breast cancer. Not all biomarkers increased post-treatment. Different parameters reflect different aspects of cardiac injury.

FIGURE 7.

Correlation maps between dose and different post-treatment strain components in the (A) sarcoma and (B) breast cancer patients at the global level (G) and regional levels (base (B), mid-ventricular (M), and apical (A). Ell, Ecc, and Err represent longitudinal, circumferential, and radial strains, respectively. There is a clear inverse correlation between strain and dose in sarcoma, which is positive for Ell and Ecc and negative for Err, as shown in the leftmost column. Such correlation pattern is not shown in the breast cancer correlation map.
Correlation maps between dose and different post-treatment strain components in the (A) sarcoma and (B) breast cancer patients at the global level (G) and regional levels (base (B), mid-ventricular (M), and apical (A). Ell, Ecc, and Err represent longitudinal, circumferential, and radial strains, respectively. There is a clear inverse correlation between strain and dose in sarcoma, which is positive for Ell and Ecc and negative for Err, as shown in the leftmost column. Such correlation pattern is not shown in the breast cancer correlation map.

FIGURE 8.

Correlation maps between dose and different 6-months follow-up strain components in the (A) sarcoma and (B) breast cancer patients at the global level (G) and regional level (base (B), mid-ventricular (M), and apical (A). Ell, Ecc, and Err represent longitudinal, circumferential, and radial strains, respectively. There is inverse correlation only between circumferential strain and dose in sarcoma, which is positive for Ecc. There is inverse correlation only between longitudinal base and mid-ventricular strains and dose in breast cancer, which is positive for Ell-B and Ell-M.
Correlation maps between dose and different 6-months follow-up strain components in the (A) sarcoma and (B) breast cancer patients at the global level (G) and regional level (base (B), mid-ventricular (M), and apical (A). Ell, Ecc, and Err represent longitudinal, circumferential, and radial strains, respectively. There is inverse correlation only between circumferential strain and dose in sarcoma, which is positive for Ecc. There is inverse correlation only between longitudinal base and mid-ventricular strains and dose in breast cancer, which is positive for Ell-B and Ell-M.

Patients’ demographic parameters

Parameter All Sarcoma Breast
Number of patients (m/f) 5/13 4/4 1/9
Number of patients – visit A (baseline) 18 8 10
Number of patients – visit B (post treatment) 14 6 8
Number of patients – visit C (6 months post follow-up) 10 4 6
Age (years) 56 ± 13 56 ± 15 55 ± 12
Body mass index (BMI) (kg/m2) 29 ± 6 27 ± 8 31 ± 4
White/Black race (n) 17/1 8/0 9/1
Non-Hispanic / Hispanic (n) 18/0 8/0 10/0
Patients with cardiovascular risk factors (n) 3 1 2
Patients with comorbidities (n) 7 5 2
Patients with cardiovascular disease (n) 1 1 0
Smoker patients (n) 7 3 4
Alcohol consumer patients (n) 8 3 5
Patients receiving cardiac medications (n) 4 3 1
Accumulative Dox dose (mg) 514 ± 190 564 ± 277 469±42

Cardiac MRI parameters

Parameter All Sarcoma Breast p
LVEF (%) - A 59 ± 11 62 ± 10 57 ± 12 0.398
LVEF (%) - B 55 ± 11 57 ± 8 53 ± 14 0.547
LVEF (%) - C 60 ± 5 58 ± 8 61 ± 2 0.489
LV mass (g/m2) - A 48 ± 10 48 ± 11 47 ± 9 0.849
LV mass (g/m2) - B 46 ± 8 51 ± 9 42 ± 5 0.049*
LV mass (g/m2) - C 49 ± 8 53 ± 9 47 ± 7 0.300
RVEF (%) - A 50 ± 10 53 ± 8 48 ± 11 0.256
RVEF (%) - B 45 ± 15 51 ± 11 40 ± 17 0.196
RVEF (%) - C 48 ± 6 50 ± 5 47 ± 7 0.468
GLS (%) - A -14 ± 2 -14 ± 2 -14 ± 2 0.849
GLS (%) - B -13 ± 2 -13 ± 2 -14 ± 2 0.272
GLS (%) - C -14 ± 1 -14 ± 1 -13 ± 1 0.468
GCS (%) - A -11 ± 2 -11 ± 3 -11 ± 1 0.880
GCS (%) - B -11 ± 3 -11 ± 3 -11 ± 2 0.733
GCS (%) - C -12 ± 2 -12 ± 2 -11 ± 2 0.546
GRS (%) - A 11 ± 3 9 ± 3 12 ± 3 0.042*
GRS (%) - B 10 ± 3 9 ± 3 10 ± 2 0.705
GRS (%) - C 10 ± 3 10 ± 3 11 ± 3 0.555
T1 (ms) - A 1264 ± 53 1275 ± 58 1255 ± 50 0.444
T1 (ms) - B 1309 ± 72 1296 ± 48 1319 ± 87 0.543
T1 (ms) - C 1289 ± 97 1213 ± 71 1339 ± 80 0.034*
T2 (ms) - A 49 ± 5 48 ± 5 49 ± 4 0.529
T2 (ms) - B 49 ± 3 48 ± 3 50 ± 3 0.204
T2 (ms) - C 50 ± 3 49 ± 2 52 ± 4 0.136
ECV (%) - A 36 ± 7 37 ± 8 35 ± 6 0.433
ECV (%) - B 35 ± 5 34 ± 6 36 ± 4 0.591
ECV (%) - C 37 ± 4 33 ± 4 39 ± 3 0.031*
Lingua:
Inglese
Frequenza di pubblicazione:
4 volte all'anno
Argomenti della rivista:
Medicina, Medicina clinica, Medicina interna, Ematologia, Oncologia, Radiologia
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