Tales from the future—nuclear cardio-oncology, from prediction to diagnosis and monitoring

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Abstract

Cancer and cardiovascular diseases (CVD) often share common risk factors, and patients with CVD who develop cancer are at high risk of experiencing major adverse cardiovascular events. Additionally, cancer treatment can induce short- and long-term adverse cardiovascular events. Given the improvement in oncological patients’ prognosis, the burden in this vulnerable population is slowly shifting towards increased cardiovascular mortality. Consequently, the field of cardio-oncology is steadily expanding, prompting the need for new markers to stratify and monitor the cardiovascular risk in oncological patients before, during, and after the completion of treatment. Advanced non-invasive cardiac imaging has raised great interest in the early detection of CVD and cardiotoxicity in oncological patients. Nuclear medicine has long been a pivotal exam to robustly assess and monitor the cardiac function of patients undergoing potentially cardiotoxic chemotherapies. In addition, recent radiotracers have shown great interest in the early detection of cancer-treatment-related cardiotoxicity. In this review, we summarize the current and emerging nuclear cardiology tools that can help identify cardiotoxicity and assess the cardiovascular risk in patients undergoing cancer treatments and discuss the specific role of nuclear cardiology alongside other non-invasive imaging techniques.

Graphical Abstract

Pathophysiological pathways interconnecting cancers and CVD: genetic predispositions, cardiovascular risk factors, and cancer-treatment-related cardiotoxicity. CVD in cancer patients (and corresponding nuclear cardiology tools) consist mainly of cancer-treatment-related cardiac dysfunction (explored with MUGA/ERNA), myocardial ischaemia (with nuclear MPI), and myocarditis (with ¹⁸F-FDG PET). Abbreviations: ¹⁸F-FDG, fluor-18-radiolabelled fluorodeoxyglucose; CVD, cardiovascular diseases; ERNA, equilibrium radionuclide angiography; MPI, myocardial perfusion imaging; MUGA, multigated acquisition; PET, positron emission tomography.

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Author and article information

Contributors

Nidaa Mikail:

ORCID: https://orcid.org/0000-0003-4896-1428

Renata Chequer

Alessio Imperiale

Alexander Meisel

Susan Bengs:

ORCID: https://orcid.org/0000-0003-2424-3894

Angela Portmann

Alessia Gimelli:

ORCID: https://orcid.org/0000-0003-3378-1723

Ronny R Buechel

Cathérine Gebhard

Alexia Rossi

Journal

Journal ID (nlm-ta): Eur Heart J Cardiovasc Imaging

Journal ID (iso-abbrev): Eur Heart J Cardiovasc Imaging

Journal ID (publisher-id): ehjcimaging

Title: European Heart Journal Cardiovascular Imaging

Publisher: Oxford University Press (US )

ISSN (Print): 2047-2404

ISSN (Electronic): 2047-2412

Publication date Collection: September 2023

Publication date (Electronic): 19 July 2023

Publication date PMC-release: 19 July 2023

Volume: 24

Issue: 9

Pages: 1129-1145