Optimising Screening for the Cardiotoxic Effects of Cancer Therapy

Cancer is a major worldwide health problem, with around 330.000 new annual cases only in the UK. Improved survival rates due to better treatments have lead to an increase in the prevalence of chemotherapy related cardiac disease (particularly with the use of anthracyclines and Trastuzumab). Since prognosis and therapeutic decisions are based on the results of these exams, the imaging technique used for sequencial follow up must faithfully reflect changes in cardiac function with the lowest intraobserver, interobserver and intra-study variabilities. The key parameter used for screening for myocardial effects of chemotherapy is the ejection fraction, measured either by echocardiography or nuclear techniques (MUGA scans) and/or CMR1. However, there are inherent problems with the sensitivity and reproducibility of ejection fraction as an imaging biomarker2,3 in this context. Advanced echocardiographic methods including myocardial strain and 3D measures offer the promise of potentially greater sensitivity for detecting early cardiac dysfunction4, however are hindered by a lack of standardisation5. Conventional CMR is the gold standard method for accuracy and reproducibility for measuring cardiac volumes and ejection fraction6, but is limited in many parts of the world by availability. To date, there is no head-to-head comparison of both accuracy and reproducibility of all three modalities performed with no temporal gap between them. The investigators will perform a multi-imaging study, where CMR, echocardiography and MUGA departments of Barts Heart Centre will work together to assess which is the best modality for cardiac surveillance in oncology patients. Whether a technique outperforms others, would clearly improve our cardio-oncology practice.

Sex

All

Minimum age

18 Years

Inclusion Criteria:

We will include 100 patients, aged 18 or above, who are already booked for cardiac imaging investigations (MUGA scan, echocardiography (TTE) or CMR) to assess their left ventricular systolic function, as part of their routine clinical care. The majority of these patients will be patients who are being screened for cardiac toxicity resulting from cancer therapies. Some patients will be pre-treatment but many will be patients who have started treatment or completed treatment.

Exclusion Criteria:

* pregnancy and breast feeding.
* standard contraindications to cardiac MRI including pacemakers/implantable defibrillators, claustrophobia.
* atrial fibrillation