Can post-chemotherapy cardiotoxicity be detected in long-term survivors of breast cancer via comprehensive 3D left-ventricular contractility (strain) analysis?
PURPOSE
This study applied a novel and automated contractility analysis tool to investigate possible cardiotoxicity-related left-ventricular (LV) dysfunction in breast cancer patients following treatment with anti-neoplastic chemotherapy agents (CTA). Subclinical dysfunction otherwise undetected via LV ejection fraction (LVEF) was determined.


METHODS
Deformation data were acquired with the Displacement Encoding with Stimulated Echoes (DENSE) MRI sequence on 16 female patients who had CTA-based treatment. The contractility analysis tool consisting of image quantization-based boundary detection and the meshfree Radial Point Interpolation Method was used to compare chamber quantifications, 3D regional strains and torsion between patients and healthy subjects (N = 26 females with N = 14 age-matched). Quantifications of patient LVEFs from DENSE and Steady-State Free Precession (SSFP) acquisitions were compared, Bland-Altman interobserver agreements measured on their strain results and differences in contractile parameters with healthy subjects determined via Student's t-tests.


RESULTS
A significant difference was not found between DENSE and SSFP-based patient LVEFs at 58 ± 7% vs 57 ± 9%, p = 0.6. Bland-Altman agreements were - 0.01 ± 0.05 for longitudinal strain and 0.1 ± 1.3° for torsion. Differences in basal diameter indicating enlargement, 5.2 ± 0.5 cm vs 4.5 ± 0.5 cm, p < 0.01, and torsion, 4.7 ± 1.0° vs 8.1 ± 1.1°, p < 0.001 in the mid-ventricle and 5.9 ± 1.2° vs 10.2 ± 0.9°, p < 0.001 apically, were seen between patients and age-matched healthy subjects and similarly in longitudinal strain, but not in LVEF.


CONCLUSIONS
Results from the statistical analysis reveal the likelihood of LV remodeling in this patient subpopulation otherwise not indicated by LVEF measurements.
['Kar|Julia|J|', 'Cohen|Michael V|MV|', 'McQuiston|Samuel A|SA|', 'Figarola|Maria S|MS|', 'Malozzi|Christopher M|CM|']
D000328:Adult D000368:Aged D000970:Antineoplastic Agents D001943:Breast Neoplasms D066126:Cardiotoxicity D005260:Female D006352:Heart Ventricles D006801:Humans D007090:Image Interpretation, Computer-Assisted D021621:Imaging, Three-Dimensional D008279:Magnetic Resonance Imaging D008875:Middle Aged D009119:Muscle Contraction D017741:Survivors D018487:Ventricular Dysfunction, Left D016277:Ventricular Function, Left D020257:Ventricular Remodeling
Cardiotoxicity Breast Cancer Left-ventricular contractility LVEF DENSE 3D strain RPIM