Cardiotoxicity Screening

This study investigated possible long-term cardiotoxicity-related left-ventricular (LV) contractile dysfunction in breast cancer patients who had treatment with anti-neoplastic chemotherapy agents (CTA). An automated cardiac contractility analysis tool consisting of quantization-based boundary detection and meshfree Radial Point Interpolation Method-based numerical analysis measured torsion and 3D strains for comparisons to healthy subjects to investigate LV remodeling otherwise not indicated by LV ejection fraction (LVEF). Data was acquired with the Displacement Encoding with Stimulated Echoes (DENSE) MRI sequence in 11 patients who had treatment with CTAs. DENSE short-axis acquisition-based LVEF quantifications were validated with similar SSFP scans in patients.  Strain results were validated with interobserver agreements established using Bland-Altman and significant differences in contractile parameters between patients and healthy subjects determined with Student’s t-tests. Significant differences were not found between DENSE and SSFP based LVEF,  54% ± 12% versus 52% ± 11% (p=0.36), respectively. Bland-Altman agreements were 0.01 ± 0.06 for longitudinal strain and 0.10° ± 1.92° for torsion. Patient LV diastolic diameters showed enlargement at 30.11 ± 5.81 mm versus 24.97 ± 3.86 mm in healthy subjects (p<0.001). Significant differences were found in torsion between the groups which were 5.47 ± 1.79 versus 8.80° ± 1.68° (p=0.01) and 6.20° ± 1.93° versus 10.64° ± 1.58° (p<0.001) for the mid-ventricular and basal subregions, respectively and similarly with longitudinal strains, but not in radial and circumferential strains or LVEF measurements. The results from the statistical analysis reveal the likelihood of LV remodeling in this patient subgroup otherwise not indicated by LVEF measurements.