Multimodality Advanced Cardiovascular and Molecular Imaging for Early Detection and Monitoring of Cancer Therapy-Associated Cardiotoxicity and the Role of Artificial Intelligence and Big Data

Abstract

Cancer mortality has improved due to earlier detection via screening, as well as due to novel cancer therapies such as tyrosine kinase inhibitors and immune checkpoint inhibitions. However, similarly to older cancer therapies such as anthracyclines, these therapies have also been documented to cause cardiotoxic events including cardiomyopathy, myocardial infarction, myocarditis, arrhythmia, hypertension, and thrombosis. Imaging modalities such as echocardiography and magnetic resonance imaging (MRI) are critical in monitoring and evaluating for cardiotoxicity from these treatments, as well as in providing information for the assessment of function and wall motion abnormalities. MRI also allows for additional tissue characterization using T1, T2, extracellular volume (ECV), and delayed gadolinium enhancement (DGE) assessment. Furthermore, emerging technologies may be able to assist with these efforts. Nuclear imaging using targeted radiotracers, some of which are already clinically used, may have more specificity and help provide information on the mechanisms of cardiotoxicity, including in anthracycline mediated cardiomyopathy and checkpoint inhibitor myocarditis. Hyperpolarized MRI may be used to evaluate the effects of oncologic therapy on cardiac metabolism. Lastly, artificial intelligence and big data of imaging modalities may help predict and detect early signs of cardiotoxicity and response to cardioprotective medications as well as provide insights on the added value of molecular imaging and correlations with cardiovascular outcomes. In this review, the current imaging modalities used to assess for cardiotoxicity from cancer treatments are discussed, in addition to ongoing research on targeted molecular radiotracers, hyperpolarized MRI, as well as the role of artificial intelligence (AI) and big data in imaging that would help improve the detection and prognostication of cancer-treatment cardiotoxicity.

Artificial intelligence-enhanced risk stratification of cancer therapeutics-related cardiac dysfunction using electrocardiographic images

“…3,15 Transthoracic echocardiography (TTE), 31 including strain imaging by GLS, 17,18 and circulating biomarker characterization with natriuretic peptide and troponin measurements, 3,[31][32][33][34] are also routinely recommended according to the risk profile of the proposed regimen and each individual patient. More recently, multimodal imaging with magnetic resonance imaging, including T1 mapping, extracellular volume (ECV) quantification, 11,14 or positron emission tomography with radiotracers tracking myocardial function, metabolism, and tissue repair have also shown value in pre-clinical or small clinical studies. 14,35,36 However, access to these technologies varies across different parts of the world, [37][38][39] underlining an unmet need for efficient cardiovascular risk stratification that can be performed at the point-of-care using readily accessible, yet personalized technologies.…”

Leveraging innovation, education, and technology for prevention and health equity: Proceedings from the cardiology oncology innovation ThinkTank 2021

“…Cardiologists can collaborate with oncologists and radiologists to expedite the collection of imaging studies for cardio-oncology AI research. Recent reviews have cataloged various ways in which AI is being applied to cardiovascular imaging in cardio-oncology (5)(6)(7)(8). Future app development may facilitate patient enrollment and engagement for prospective validation studies.…”

Guideline-directed medical therapy in chemotherapy-induced cardiotoxicity and heart failure: current perspectives and practices

“…Emerging technologies and tools are revolutionizing the field of cardiotoxicity [71][72][73][74] . Advanced imaging techniques, cardiac magnetic resonance, omics technologies, machine learning, biosensors, wearable devices, and digital health solutions are being harnessed to improve risk assessment, early detection, and personalized intervention.…”