Radiotherapy-Induced Cardiotoxicity: The Role of Multimodality Cardiovascular Imaging
Radiotherapy (RT) is one of the pillars of cancer therapy. High-dose radiation exposure on the thorax is mainly used in the context of adjuvant RT after breast surgery, in lung and esophageal cancer, and as a complement to systemic treatment in lymphoma. Due to the anatomical proximity, the heart in...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-07-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.887705/full |
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| author | Tomaž Podlesnikar Tomaž Podlesnikar Boštjan Berlot Jure Dolenc Katja Goričar Tanja Marinko Tanja Marinko |
| author_facet | Tomaž Podlesnikar Tomaž Podlesnikar Boštjan Berlot Jure Dolenc Katja Goričar Tanja Marinko Tanja Marinko |
| author_sort | Tomaž Podlesnikar |
| collection | DOAJ |
| description | Radiotherapy (RT) is one of the pillars of cancer therapy. High-dose radiation exposure on the thorax is mainly used in the context of adjuvant RT after breast surgery, in lung and esophageal cancer, and as a complement to systemic treatment in lymphoma. Due to the anatomical proximity, the heart inevitably receives some radiation that can result in acute and chronic cardiotoxicity, leading to heart failure, coronary artery disease, pericardial and valvular heart disease. Current evidence suggests there is no safe radiation dose to the heart, which poses a need for early recognition of RT-induced cardiac injury to initiate cardioprotective treatment and prevent further damage. Multimodality cardiac imaging provides a powerful tool to screen for structural and functional abnormalities secondary to RT. Left ventricular ejection fraction, preferably with three-dimensional echocardiography or cardiovascular magnetic resonance (CMR), and global longitudinal strain with speckle-tracking echocardiography are currently the key parameters to detect cardiotoxicity. However, several novel imaging parameters are tested in the ongoing clinical trials. CMR parametric imaging holds much promise as T1, T2 mapping and extracellular volume quantification allow us to monitor edema, inflammation and fibrosis, which are fundamental processes in RT-induced cardiotoxicity. Moreover, the association between serum biomarkers, genetic polymorphisms and the risk of developing cardiovascular disease after chest RT has been demonstrated, providing a platform for an integrative screening approach for cardiotoxicity. The present review summarizes contemporary evidence of RT-induced cardiac injury obtained from multimodality imaging—echocardiography, cardiovascular computed tomography, CMR and nuclear cardiology. Moreover, it identifies gaps in our current knowledge and highlights future perspectives to screen for RT-induced cardiotoxicity. |
| first_indexed | 2024-12-11T16:20:24Z |
| format | Article |
| id | doaj.art-532b0dabd3854354a71c05a1257c1972 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-12-11T16:20:24Z |
| publishDate | 2022-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-532b0dabd3854354a71c05a1257c19722022-12-22T00:58:51ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-07-01910.3389/fcvm.2022.887705887705Radiotherapy-Induced Cardiotoxicity: The Role of Multimodality Cardiovascular ImagingTomaž Podlesnikar0Tomaž Podlesnikar1Boštjan Berlot2Jure Dolenc3Katja Goričar4Tanja Marinko5Tanja Marinko6Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, SloveniaDepartment of Cardiac Surgery, University Medical Centre Maribor, Maribor, SloveniaDepartment of Cardiology, University Medical Centre Ljubljana, Ljubljana, SloveniaDepartment of Cardiology, University Medical Centre Ljubljana, Ljubljana, SloveniaPharmacogenetics Laboratory, Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, SloveniaDepartment of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, SloveniaFaculty of Medicine, University of Ljubljana, Ljubljana, SloveniaRadiotherapy (RT) is one of the pillars of cancer therapy. High-dose radiation exposure on the thorax is mainly used in the context of adjuvant RT after breast surgery, in lung and esophageal cancer, and as a complement to systemic treatment in lymphoma. Due to the anatomical proximity, the heart inevitably receives some radiation that can result in acute and chronic cardiotoxicity, leading to heart failure, coronary artery disease, pericardial and valvular heart disease. Current evidence suggests there is no safe radiation dose to the heart, which poses a need for early recognition of RT-induced cardiac injury to initiate cardioprotective treatment and prevent further damage. Multimodality cardiac imaging provides a powerful tool to screen for structural and functional abnormalities secondary to RT. Left ventricular ejection fraction, preferably with three-dimensional echocardiography or cardiovascular magnetic resonance (CMR), and global longitudinal strain with speckle-tracking echocardiography are currently the key parameters to detect cardiotoxicity. However, several novel imaging parameters are tested in the ongoing clinical trials. CMR parametric imaging holds much promise as T1, T2 mapping and extracellular volume quantification allow us to monitor edema, inflammation and fibrosis, which are fundamental processes in RT-induced cardiotoxicity. Moreover, the association between serum biomarkers, genetic polymorphisms and the risk of developing cardiovascular disease after chest RT has been demonstrated, providing a platform for an integrative screening approach for cardiotoxicity. The present review summarizes contemporary evidence of RT-induced cardiac injury obtained from multimodality imaging—echocardiography, cardiovascular computed tomography, CMR and nuclear cardiology. Moreover, it identifies gaps in our current knowledge and highlights future perspectives to screen for RT-induced cardiotoxicity.https://www.frontiersin.org/articles/10.3389/fcvm.2022.887705/fullradiotherapycardiotoxicityheart failuremultimodality cardiovascular imagingechocardiographycardiovascular magnetic resonance |
| spellingShingle | Tomaž Podlesnikar Tomaž Podlesnikar Boštjan Berlot Jure Dolenc Katja Goričar Tanja Marinko Tanja Marinko Radiotherapy-Induced Cardiotoxicity: The Role of Multimodality Cardiovascular Imaging Frontiers in Cardiovascular Medicine radiotherapy cardiotoxicity heart failure multimodality cardiovascular imaging echocardiography cardiovascular magnetic resonance |
| title | Radiotherapy-Induced Cardiotoxicity: The Role of Multimodality Cardiovascular Imaging |
| title_full | Radiotherapy-Induced Cardiotoxicity: The Role of Multimodality Cardiovascular Imaging |
| title_fullStr | Radiotherapy-Induced Cardiotoxicity: The Role of Multimodality Cardiovascular Imaging |
| title_full_unstemmed | Radiotherapy-Induced Cardiotoxicity: The Role of Multimodality Cardiovascular Imaging |
| title_short | Radiotherapy-Induced Cardiotoxicity: The Role of Multimodality Cardiovascular Imaging |
| title_sort | radiotherapy induced cardiotoxicity the role of multimodality cardiovascular imaging |
| topic | radiotherapy cardiotoxicity heart failure multimodality cardiovascular imaging echocardiography cardiovascular magnetic resonance |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.887705/full |
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