European Radiology: CMR assessment of myocardial microvascular function in patients undergoing chemotherapy for gynecologic malignancies

As survival and survival in cancer patients improve, it is increasingly important to identify chemotherapy-related cardiotoxicity in predicting prognosis.

Gynecological malignancies are a major threat to women's health, and the cardiovascular complications associated with their treatment cannot be ignored
.
Several chemotherapy drugs commonly used for gynecologic malignancies have been reported to cause vasotoxicity, and myocardial ischemia and infarction
associated with the use of these drugs have been reported in many patients.
However, the effect of chemotherapy on myocardial microcirculation in patients with gynaecological malignancies remains unclear
.

Cardiac magnetic resonance (CMR) first-pass perfusion is an ideal modality for detecting myocardial ischemia, with the distinct advantages
of high spatial resolution and diagnostic accuracy.
In fact, CMR first-pass perfusion can reflect myocardial microvascular dysfunction
in various heart diseases.
Because the use of chemotherapy to treat gynecologic malignancies may cause myocardial damage, assessing myocardial perfusion may help with cardiac risk stratification and treatment decisions
.
However, first-pass CMR perfusion has not been widely practiced
in these patients.

Recently, a study published in the journal European Radiology used CMR first-pass perfusion to evaluate changes in myocardial microvascular function and their risk factors
in patients receiving chemotherapy for gynecologic malignancies.

A total of 81 gynecologic malignancy patients and 39 healthy volunteers undergoing chemotherapy were prospectively included in the study, and each patient also underwent CMR imaging.

Of these patients, 32 completed CMR follow-up with a median interval of 6 months
.
CMR sequences include cardiac film, resting first-pass perfusion, and late gadolinium enhancement
.

There were no significant differences in baseline characteristics between patients and normal controls (all p > 0.
05).

Compared with normal controls, patients had a lower myocardial perfusion index (PI) (13.
62 ± 2.
01% vs.
12% (11 to 14%), p = 0.
001), but there was no significant change with the increase in the number of chemotherapy cycles (11.
79 ± 2.
36% vs.
11.
19 ± 2.
19%, p = 0.
234).

。 In multivariate analyses adjusted for clinical confounders, reductions in PI were independently associated with chemotherapy (β = -0.
362, p = 0.
002) but not with the number of chemotherapy cycles (r = -0.
177, p = 0.
053).

Figure A shows the CMR first-pass perfusion image, and B shows the contours of the central muscle and blood pool analyzed by the image; C shows the time signal curve derived by the post-processing software: the orange curve is the time signal curve of the blood pool, and the other color curves are the time signal curve
of the myocardium.
PI is calculated as the maximum slope of the heart muscle divided by the slope of the blood pool
.
Abbreviations: CMR = Cardiac Magnetic Resonance; PI = Perfusion Index

This study found that continuous chemotherapy was associated with myocardial microvascular dysfunction in patients with gynecological malignancies, but there was no trend
of aggravation.
This study also showed that resting CMR first-pass perfusion is an ideal imaging modality
to assess and monitor changes in myocardial microcirculation during chemotherapy.

Original source:

Meng-Xi Yang,Qing-Li Li,Dan-Qing Wang,et al.
Myocardial microvascular function assessed by CMR first-pass perfusion in patients treated with chemotherapy for gynecologic malignancies.
DOI:10.
1007/s00330-022-08823-2