CMR in the management of toxicity in oncology patients

Background: Anthracycline in Hodgkin and non-Hodgkin Lymphoma is associated with a cumulative dose-dependent nonischemic cardiomyopathy. Cardiac magnetic resonance imaging (CMRI) can examine both structural, functional and tissue components of the myocardium. Objectives: The aim of this study was to assess the earlier myocardial changes using CMR in patients affected by lymphoma treated with an anthracycline-based chemotherapy. Material and Methods: 22 newly diagnosed patients were enrolled in the present study from March2019 to December 2021. CMR examination was performed in 20 patients at the end of the planned chemotherapy program (83% ABVD regimen and17% R-CHOP scheme, including 6% patients with a liposomal Doxorubicine formulation) and after 6 months. Left ventricular ejection fraction (LVEF), cardiac deformation parameters (GLS and GCS LV and RV’s strain), tissue analysis (T2 mapping, T1 mapping with native and enhanced) and delayed enhancement (GD-DE) were quantified for each CMR. The change between LVEF, cardiac deformation and tissue parameters and DE were compared between the two CMR examination performed. A delta LVEF>=10% was considered clinically relevant, but a delta LVEF<10% with EF <60% was also evaluated in correlation to variations of deformation and tissue parameters. The findings of strain, T2, T1 mapping and delay enhancement (DE) were additionally analyzed as independent variables. Results: All 20 enrolled patients received 6 cycles of chemotherapy followed in 3 patients by a consolidative radiotherapy for a bulky localization. A comparison between 2 CMR exams demonstrated 2 patients with >=10% decrease in LVEF. The RV global circumferential strain was significantly lower in 50% of patients after 6 months after treatment, as compared with values of normal controls. In the second CMR evaluation 20% of patients showed an increased T2 mapping almost in 1 segment whereas T1 mapping native and enhanced remained pathologic respectively in 55%,50% of patients. 60% of patients had at least 1 segment of delay enhancement during first CMR exam and a subgroup -15% showed a further segmental extension of DE. Conclusion: our data suggests that CMR may be used to assess both early functional, structural and tissue myocardial changes in lymphoma patients at risk to cardiomyopathy for receiving anthracycline based therapy.