Diastolic assessment by CZT-SPECT: Could it be the next best thing for the detection of subclinical chemotherapy-induced cardiotoxicity?

Abstract

See related article, pp. 1193-1201 Advancements in modern medicine have resulted in a continuously growing population of survivors of adult and pediatric malignancies. 1 This is paralleled by an increased recognition of the cardiac damage induced by chemotherapy and radiation therapy, collectively termed ''cancer therapeutics-related cardiac dysfunction'' (CTRCD). 2 It is now well established that, left untreated, CTRCD may result in numerous adverse cardiovascular effects, namely, left ventricular (LV) dysfunction, congestive heart failure, and ultimately increased cardiovascular mortality. 3 Myocardial recovery and improved survival rely on early diagnosis of CTRCD and prompt initiation of medical therapy. 3 Noninvasive cardiac imaging has been traditionally used to detect CTRCD, namely, 2-D echocardiography (Echo), cardiac magnetic resonance (CMR), and radionuclide imaging (multi-gated acquisition, MUGA, and singlephoton emission computed tomography, SPECT). 2,4,5 These modalities are mostly geared towards quantifying the left ventricular ejection fraction (LVEF), as an index of the status of LV systolic function. 4 It is becoming increasingly evident though, that reduction in the LVEF may signify advanced and possibly irreversible cardiac damage. This emphasizes the need for detection of markers of subclinical cardiotoxicity.