Background:Our goal was to evaluate the ability of cardiovascular magnetic resonance for detecting and predicting cardiac dysfunction in patients receiving cancer therapy. Left ventricular ejection fraction, global and regional strain utilizing fast-strain-encoded, T1 and T2 mapping, and cardiac biomarkers (troponin and BNP [brain natriuretic peptide]) were analyzed.Methods:Sixty-one patients (47 with breast cancer, 11 with non-Hodgkin lymphoma, and 3 with Hodgkin lymphoma) underwent cardiovascular magnetic resonance scans at baseline and at regular intervals during 2 years of follow-up. The percentage of all left ventricular myocardial segments with strain ≤−17% (normal myocardium [%]) was analyzed. Clinical cardiotoxicity (CTX) and sub-CTX were defined according to standard measures.Results:Nine (15%) patients developed CTX, 26 (43%) had sub-CTX. Of the 35 patients with CTX or sub-CTX, 24 (69%) were treated with cardioprotective medications and showed recovery of cardiac function. The amount of normal myocardium (%) exhibited markedly higher accuracy for the detection of CTX and sub-CTX compared with left ventricular ejection fraction, T1, and T2 mapping as well as troponin I (Δareas under the curve=0.20, 0.24, and 0.46 for normal myocardium (%) versus left ventricular ejection fraction, troponin I, and T1 mapping, P<0.001 for all). In addition, normal myocardium (%) at baseline accurately identified patients with subsequent CTX (P<0.001), which was not achieved by any other markers.Conclusions:Normal myocardium (%) derived by fast-strain-encoded cardiovascular magnetic resonance, is an accurate and sensitive tool that can establish cardiac safety in patients with cancer undergoing cardiotoxic chemotherapy not only for the early detection but also for the prediction of those at risk of developing CTX.Registration:URL: https://www.clinicaltrials.gov; Unique identifier: NCT03543228.

中文翻译：

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使用心肌应变、T1 和 T2 绘图以及生化标记物进行心脏毒性的多参数早期检测和预测：2 年随访期间的纵向心脏共振成像研究

背景：我们的目标是评估心血管磁共振检测和预测接受癌症治疗的患者心功能障碍的能力。分析了左心室射血分数、利用快速应变编码的整体和局部应变、T1 和 T2 映射以及心脏生物标志物（肌钙蛋白和 BNP [脑钠尿肽]）。 方法：61 名患者（47 名乳腺癌患者，11 名患者）患有非霍奇金淋巴瘤和 3 名霍奇金淋巴瘤）在基线时和在 2 年随访期间定期接受心血管磁共振扫描。分析所有左心室心肌节段应变≤−17%（正常心肌[%]）的百分比。临床心脏毒性（CTX）和亚CTX根据标准措施进行定义。结果：9名（15%）患者出现CTX，26名（43%）患者出现亚CTX。在 35 名 CTX 或亚 CTX 患者中，24 名 (69%) 接受了心脏保护药物治疗，并显示出心功能恢复。与左心室射血分数、T1和T2图以及肌钙蛋白I相比，正常心肌量（%）对于CTX和亚CTX的检测表现出明显更高的准确度（曲线下的Δ面积=0.20、0.24和0.46）正常心肌 (%) 与左心室射血分数、肌钙蛋白 I 和 T1 映射的比较，所有P <0.001）。此外，基线时的正常心肌 (%) 能够准确识别随后发生 CTX 的患者 ( P <0.001)，这是任何其他标志物都无法实现的。结论：通过快速应变编码心血管磁共振得出的正常心肌 (%) 是一种准确而灵敏的工具，可以确定接受心脏毒性化疗的癌症患者的心脏安全性，不仅可以用于早期检测，还可以用于预测那些有发生 CTX 风险的患者。唯一标识符：NCT03543228。