CORRESPONDENCE: LETTER TO THE EDITOR
Reply
Edward T.H. Yeh, MD*,
Guilherme H. Oliveira, MD and
Courtney Bickford, PharmD, BCPS
* The University of Texas, MD Anderson Cancer Center, Department of Cardiology, 1400 Pressler Street, Room 11.5028, Houston, Texas 77030-3722 (Email: etyeh{at}mdanderson.org).
We thank Drs. Ntim and Hundley for their interest in our paper (1) and their comments regarding the role of cardiac magnetic resonance (CMR) in the evaluation of cardiac complications of cancer therapy. We agree that CMR has a well-defined and expanding role in the evaluation and management of cardiac disease in general, with specific value in cardiovascular structure, function, and physiology (2). The use of CMR in cardiotoxicity, however, has only been evaluated in a preliminary fashion. One study (3) with a limited number of patients and without biopsy correlation, suggested that CMR could be used as a prognosticator of future cardiomyopathy. A 10-patient case series evaluated the value of CMR in confirming the presence of left ventricular dysfunction and demonstrated late gadolinium enhancement in patients with cardiomyopathy. Delayed enhancement CMR was also used to demonstrate abnormalities in patients with late-onset cardiomyopathy in isolated case reports (4,5).
The ability of delayed gadolinium enhancement CMR to diagnose myocardial pathology makes it an attractive method to evaluate patients at risk for antineoplastic cardiotoxicity. However, as of yet there have been no studies correlating findings of CMR to endomyocardial biopsies, which is the gold standard. In addition, the total number of patients studied to this day remains very small. Because of this lack of data we do not routinely use CMR at M. D. Anderson Cancer Center for the purpose of screening or following patients with cardiotoxicity.
In conclusion, whereas we felt it would be premature to include CMR in a state-of-the-art paper, we feel strongly that this technology merits further investigation and certainly has the potential to benefit patients with cardiotoxicity related to cancer treatment.
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1. Yeh ETH, Bickford CL. Cardiovascular complications of cancer therapy J Am Coll Cardiol 2009;53:2231-2247.[Abstract/Free Full Text]2. Hendel RC, Patel MR, Kramer CM, et al. ACCF/ACR/SCCT/SCMR/ASNC/NASCI/SCAI/SIR 2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging: a report of the American College of Cardiology Foundation Quality Strategic Directions Committee Appropriateness Criteria Working Group, American College of Radiology, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, American Society of Nuclear Cardiology, North American Society for Cardiac Imaging, Society for Cardiovascular Angiography and Interventions, and Society of Interventional Radiology J Am Coll Cardiol 2006;48:1475-1497.[Free Full Text] 3. Wassmuth R, Lentzsch S, Erdbruegger U, et al. Subclinical cardiotoxic effects of anthracyclines as assessed by magnetic resonance imaging—a pilot study Am Heart J 2001;141:1007-1013.[CrossRef][Web of Science][Medline] 4. Perel RD, Slaughter RE, Strugnell WE. Subendocardial late gadolinium enhancement in two patients with anthracycline cardiotoxicity following treatment for Ewing's sarcoma J Cardiovasc Magn Reson 2006;8:789-791.[CrossRef][Web of Science][Medline] 5. Catalano O, Antonaci S, Moro G, Baldi M, Cobelli F, Opasich C. Contrast-enhanced cardiac magnetic resonance in a patient with chemotoxic cardiomyopathy J Cardiovasc Med (Hagerstown) 2007;8:214-215.[Medline]
Related Article
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Imaging Surveillance for Cardiovascular Complications of Cancer Therapy
- William O. Ntim and W. Gregory Hundley
J. Am. Coll. Cardiol. 2010 55: 171-172.
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