Cardiotoxicity may result from a range of chemotherapeutic agents. The prevalence of cardiotoxicity from certain cytotoxic agents is reported to be significantly high. In addition to serious side effects and increased long-lasting morbidity and mortality, dose limitation and suboptimal usage is an important adverse effect. Nuclear cardiac imaging has played a quintessential and important role in identifying patients at risk and in the prevention and reduction of cardiac injury resulting from cytotoxic agents. Despite exploring a number of other diagnostic imaging or biochemical tools for identification of cardiac injury, nuclear cardiac imaging in the form of radionuclide angiocardiography continues to be the most suitable and cost-effective tool for reducing the prevalence of cases of cardiac dysfunction resulting from chemotherapy. This article reviews the prevalence, mechanisms, and prevention strategies for cardiotoxicity associated with some of the commonly known cytotoxic agents and the role of nuclear cardiac imaging in its monitoring and prevention, along with recent advances in this area.

3-Iodobenzylguanidine↗

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Pharmacologic stress perfusion imaging with adenosine: role of simultaneous low-level treadmill exercise.

BACKGROUND: Adenosine is commonly used for pharmacologic stress myocardial perfusion imaging (MPI). However, it frequently results in adverse effects, and the subdiaphragmatic tracer uptake may interfere with the image interpretation. Our aim was to determine the feasibility of combining low-level treadmill exercise with adenosine MPI and its impact on adverse effects, image quality, and myocardial ischemia. METHODS AND RESULTS: Forty-one patients underwent technetium 99m sestamibi single photon emission computed tomography following adenosine and adenosine with low-level exercise (adenosine-Ex) on separate occasions and rest MPI. A comparison was made of symptoms, hemodynamic response, electrocardiographic changes, image quality, and image interpretation between the 2 protocols. With adenosine-Ex, fewer patients had one or more adverse effects (61% vs 90%; P =.006), more patients had ischemic electrocardiographic changes (34% vs 15%; P =.03), a higher percentage had excellent- or fair-quality images (88% vs 61%; P =.003), and they had higher heart-liver ratios (1.0 +/- 0.37 vs 0.84 +/- 0.29; P =.002) compared with adenosine alone. Four adenosine MPI studies, but only 2 adenosine-Ex studies, were uninterpretable because of excessive subdiaphragmatic radiotracer activity. Of the 39 patients with at least 1 interpretable stress study, interpretation was discordant in 11 (28%): 7 showed greater ischemia with adenosine-Ex, 2 uninterpretable adenosine studies were interpretable with adenosine-Ex, and 2 studies interpreted as abnormal with adenosine were normal by adenosine-Ex (both had normal coronary angiograms). CONCLUSIONS: Simultaneous low-level treadmill exercise with adenosine Tc-99m sestamibi imaging is safe and feasible, significantly reduces unfavorable side effects, enhances image quality, and may result in greater ischemia detection compared with adenosine alone.

Adenosine↗

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Doxorubicin cardiotoxicity: prevention of congestive heart failure with serial cardiac function monitoring with equilibrium radionuclide angiocardiography in the current era.

BACKGROUND: Congestive heart failure (CHF) is among the most serious toxicities of doxorubicin, a potent cancer chemotherapeutic agent. Serial left ventricular ejection fraction (LVEF) monitoring during doxorubicin therapy for preventing CHF was proposed over 20 years ago. The current utility and cost-effectiveness of this approach in the present era are not known. METHODS AND RESULTS: Clinical and follow-up data of 265 patients with cancer (age, 53 +/- 14 years; 76% women) undergoing doxorubicin chemotherapy with serial equilibrium radionuclide angiocardiography (ERNA) monitoring (> or =2 studies) were analyzed retrospectively. Patients with a normal baseline LVEF (> or =50%) and a 10% or greater point fall in LVEF to a final value of less than 50% during doxorubicin therapy were considered "at risk" for CHF (n = 41). Over 679 +/- 426 days of follow-up, 7 patients (2.6%) had CHF develop and 90 (34%) died (all cancer-related deaths, with none due to CHF). A comparison of "at-risk" (n = 41 [15%]) and "low-risk" (n = 224 [85%]) groups showed a higher incidence of CHF (12% vs 0.9%, P <.0001), lower baseline LVEF (58% +/- 8% vs 64% +/- 8%, P <.0001), lower value for the lowest LVEF (42% +/- 8% vs 57% +/- 7%, P <.0001), and higher rate of cancer-related deaths (59% vs 29%, P =.0003) in the former despite similar cumulative doxorubicin dose (304 +/- 124 mg/m(2) vs 284 +/- 110 mg/m(2), P = not significant). There were no differences in age, gender, cancer type, and co-morbidity. Cost analysis showed the overall cost of ERNA studies to be lower than the 1-year cost of caring for additional cases of CHF that would potentially be prevented by routine LVEF monitoring. CONCLUSIONS: An incipient fall in LVEF detected on serial ERNA during doxorubicin therapy provides an appropriate and cost-effective approach for predicting and preventing impending CHF. Use of this approach was associated with a low incidence of CHF (2.6%) and no CHF-related mortality in this study.

Antineoplastic Agents↗

PubMedDate not supplied

Psychological traits and emotion-triggering of ICD shock-terminated arrhythmias.

OBJECTIVE: We have previously reported on the triggering of arrhythmia and hence, implanted cardioverter-defibrillators (ICD) shock by strong emotion. The purpose of the present study was to examine whether concordant psychological traits distinguish patients who experience emotion-triggered ICD shock. METHODS: Two hundred forty ICD patients completed the Speilberger Trait Anxiety and Anger Inventories and Anger Expression Scale, and the abridged Cook-Medley Hostility Scale approximately 2 months after ICD implantation. Patients were also given a structured diary to record mood states retrospectively for the period 0 to 15 minutes preceding ICD shock and for a period corresponding to the same time of day 1 week later. Patients who reported emotion-triggered ICD shock were compared on concordant psychological measures to patients who did not. RESULTS: Patients who reported at least moderate anger in the 0 to 15 minutes before ICD shock scored significantly higher on Speilberger Trait Anger (24.18 +/- 3.97 vs. 17.04 +/- 2.17, p < .0001), and Cook-Medley Aggressive Responding (5.76 +/- 0.75 vs. 3.96 +/- 1.30, p < .0001) and Hostile Affect (3.59 +/- 0.80 vs. 2.04 +/- 1.02, p < .0001), and lower on Speilberger Anger Control (7.94 +/- 1.43 vs. 10.64 +/- 1.19, p < .001) than those who did not. In multivariate analysis, only Trait Anger remained a significant predictor of anger-triggered shock (chi2 = 7.10, p < .008). Patients who reported at least moderate anxiety in the 0 to 15 minutes before ICD shock scored significantly higher on Speilberger Anxiety (22.43 +/- 1.65 vs. 19.96 +/- 1.71, p < .0001) than those who did not. CONCLUSION: Stable psychological factors are associated with risk for ICD-shock triggered by concordant strong emotion.

Aged↗