Cardio Oncology

1349140 - Identification of subclinical myocardial dysfunction by fastSENC cardiac magnetic resonance imaging in cardio-oncology patients

Thursday, January 26, 2023

4:30 PM – 5:10 PM

Location: Pacific Jewel

Presenting Author(s)

Olga H. Toro-Salazar, MD

Head of Non-Invasive Imaging and Cardio-Oncology
Connecticut Children's Medical Center
Glastonbury, Connecticut, United States

Primary Author(s)

Olga H. Toro-Salazar, MD

Head of Non-Invasive Imaging and Cardio-Oncology
Connecticut Children's Medical Center
Glastonbury, Connecticut, United States

Co-Author(s)

TR

Tiffany Ruiz, RN

Cardiology-Oncology Nurse Coordinator
Connecticut Children's Medical Center
Hartford, Connecticut, United States
JW

James Whayne, MSc

Chief Clinical Officer
Myocardial Solutions, Inc., United States
Xiaoying Cai, BEng

MR R&D Collaborations
Siemens Medical Solutions USA, Inc.
Boston, Massachusetts, United States
FO

Farouk Osman, BSc

Data Research Analyst
Myocardial Solutions, Inc., United States
MB

Michael Brimacombe, PhD

Sr. Advisory Biostatistician
Connecticut Children's Medical Center, United States
AO

Andrea Orsey, MD

Associate Chair of Education Program Director, Pediatric Hematology/Oncology Fellowship
Connecticut Children's Medical Center, United States
Anudeep K. Dodeja, MD

Associate Director Adult Congenital Heart Disease
Connecticut Children's
Hartford, Connecticut, United States

Disclosure(s):

Olga H. Toro-Salazar, MD: No financial relationships to disclose

Background: Cancer therapy related cardiac dysfunction (CTRCD) is a major contributing factor to morbidity and mortality in pediatric oncology patients exposed to cardiotoxic medications.^{1, 2} Advanced tagged CMR sequences, such as fast-SENC, enable quantification of global longitudinal (GLS) and circumferential strain (GCS) magnitude and parameters of regional systolic and diastolic dyssynchrony: standard deviation of time to peak strain (SD-TPS), correlation (consistent timing and shape of longitudinal strain curves), pre-and post-systolic septal slopes ^{3, 4} adding to our understanding of myocardial mechanical adaptation to cardiac injury. The objective of this pilot study is to assess the feasibility of fast-strain encoded magnetic resonance (fastSENC) to identify subclinical myocardial dysfunction in pediatric cancer patients exposed to cardiotoxic therapy.

Methods:

Twelve subjects, (Median/IQ) 18.5, 2.0 years, with cumulative anthracycline (AC) doses 317.8, 266.6 g/m², 5/12 (41.7%) female underwent CMR with a 3T scanner (MAGNETOM Vida, Siemens Healthcare, Erlangen, Germany) for clinical reasons between April-September 2022. LV volumes, mass, mass/volume, end systolic fiber stress ESFS, ejection fraction (EF), stroke volume index (SVi) and RV and LV global circumferential (GCS) and longitudinal strain (GLS) and percentage of myocardial segments with strain ≤ -17% (MyoHealth) acquired with a prototype fast-SENC sequence, were calculated in all subjects. Patients were risk stratified based on the known CV and cancer treatment related risk factors of cardiotoxicity and given a composite score to categorize them in low, moderate and high risk. Fast-SENC variables were compared to echo and CMR derived measures of global and regional myocardial function.

Results:

CMR derived LV and RV EF, SVi, LV GLS, GCS, RV GCS and MyoHealth decreased with increasing heart failure stage and correlated with composite risk score of cardiotoxicity (Table 1). Cardio-Oncology patients had reduced function by MyoHealth (Figure 1) and MyoStrain parameters of dyssynchrony (SD-TPS, presystolic septal slope and average longitudinal strain correlation coefficient when compared to normal (n=6) (Figure 2). Patients in active treatment had lower MyoHealth and strain parameters of regional systolic and diastolic dyssynchrony. Abnormal MyoHealth identified 4 patients with subclinical LV dysfunction with normal LV EF by CMR, 8 patients with normal EF by 2D and 5 patients with normal EF 3D echocardiography.

Conclusion:

MyoHealth as determined by fast-SENC, enables improved identification of patients with subclinical LV dysfunction compared with LV ejection fraction by CMR and 2D and 3D echocardiography. Subclinical abnormalities in LV GLS, GCS, RV GCS and parameters of regional systolic and diastolic dyssynchrony are highly prevalent. Ability to identify subclinical myocardial dysfunction in patients at high risk for cardiotoxicity may allow early therapeutic intervention and improved outcomes.