ISSN 2996-8215
International Journal of Cardiology | Vol. 10, No. 4, April 2019 | pp. 25–32
DOI: 10.46882/2019/IJC/000121
Original Research Article
The Role of Cardiovascular Magnetic Resonance Native T1 Mapping in the Early Detection of Anthracycline-Induced Cardiotoxicity
Emily C. Thorne¹, William H. Edwards²
¹Department of Cardio-Oncology, Royal Marsden Hospital, London, United Kingdom
²Division of Cardiology, Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
Abstract:
Early identification of anthracycline-induced cardiotoxicity is critical to prevent irreversible heart failure in cancer survivors. While global longitudinal strain can reveal subclinical mechanical impairment, it reflects macroscopic alterations. This study investigated whether non-invasive cardiac magnetic resonance (CMR) native T1 mapping can detect earlier microstructural diffuse myocardial injury before structural deformation occurs. We prospectively followed 95 breast cancer and lymphoma patients undergoing doxorubicin-based chemotherapy regimens (cumulative dose greater than or equal to 240 mg/m²). Baseline and serial 3-month CMR imaging sessions quantified native T1 values and extracellular volume (ECV) fractions. Left ventricular ejection fraction (LVEF) was tracked simultaneously. Cardiotoxicity was defined as an absolute LVEF decline greater than 10% or a drop below 50% at 12 months. Cardiotoxicity developed in 18 patients (18.9%) at 12 months. In these patients, native T1 values increased significantly from baseline at the 3-month evaluation point (from 984 ± 22 ms to 1042 ± 28 ms, p < 0.01), predating LVEF drops by an average of 6 months. ECV fractions rose concurrently from 25.4% ± 1.8% to 29.2% ± 2.1% (p < 0.05). Multivariable Cox regression confirmed that a 3-month native T1 increase greater than 50 ms was an independent predictor of subsequent clinical cardiotoxicity (hazard ratio: 2.65, 95% CI: 1.45–4.84, p = 0.002). Cardiovascular magnetic resonance native T1 mapping serves as a highly sensitive tool for the early detection of diffuse subclinical myocardial changes induced by anthracyclines, offering an earlier window for cardioprotective intervention than traditional ejection fraction tracking.
Keywords: Cardio-oncology, Anthracyclines, Cardiotoxicity, Cardiac magnetic resonance, T1 mapping, Extracellular volume
Received: January 10, 2019; Revised: February 22, 2019; Accepted: March 15, 2019; Published: April 18, 2019