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Imaging the Cardiovascular System in the Cancer Patient

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Nuclear Oncology

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Abstract

The average age of a cancer patient at diagnosis is 66 years. At the time of diagnosis patients with cancer are likely to have multiple comorbidities. Patients >55 years old have an average of ∼2.9 comorbidities, while cancer patients older than 75 have an average of 4.2 comorbidities. The likelihood of coronary artery disease as a comorbidity increases with patient age. An additional risk factor is limited work capacity; patients who cannot perform at least four metabolic equivalents of work (METS) have an increase in all-cause mortality. Patients with cancer and comorbidities or risk factors such as diabetes, hypertension, smoking history, or limited work capacity should have medical clearance prior to invasive diagnostic procedures, major surgery, mediastinal radiation, and/or administration of potentially cardiotoxic chemotherapy.

Information from medical records will permit calculation of a clinical score to define the risk of adverse events as a result of a major diagnostic or surgical procedure. Stress testing with cardiac imaging should be done in patients with an intermediate risk of coronary heart disease, and should be considered in patients with limited work capacity or advanced age. In selected patients, coronary CT angiography or coronary calcium score may be a suitable evaluation. In patients with cancer of the esophagus, breast, lung, melanoma, or lymphoma, chest-CT and 18F-FDG PET/CT studies should be carefully evaluated to detect pericardial or myocardial involvement.

Chemotherapy may cause myocardial ischemia due to coronary spasm and/or decreased ventricular function due to irreversible or reversible myocardial damage, as well as repolarization abnormalities, which may result in fatal arrhythmia. Radiotherapy may accelerate the development of atherosclerosis of vessels in the radiation field and cause irreversible damage to myocardium in the radiation field.

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Abbreviations

ACC:

American College of Cardiology

ACE:

Angiotensin-converting enzyme

AHA:

American Heart Association

AL:

Light chain amyloid

AMI:

Acute myocardial infarction

ASCO:

American Society of Clinical Oncology

ATP:

Adenosine triphosphate

ATTR:

Transthyretin amyloid

BNP:

B-type natriuretic peptide

CAD:

Coronary artery disease

CHF:

Congestive heart failure

CI:

Confidence interval

C-MRI:

Cardiac magnetic resonance imaging

COPD:

Chronic obstructive pulmonary disease

CRCD:

Chemotherapy-related cardiac dysfunction

CRP:

C-reactive protein

CT:

X-ray computed tomography

CTCAE:

Common terminology criteria for adverse events

DTPA:

Diethylenetriaminepentaacetic acid

DVT/PE:

Deep venous thrombosis/pulmonary embolism

EDTA:

Ethylenediaminetetraacetic acid

ErbB2:

A member of the tyrosine-protein kinase family (also known as CD340)

[18F]FDG:

2-deoxy-2-[18F]fluoro-d-glucose

HER2:

Human epidermal growth factor receptor 2

HR:

Hazard ratio

HRP:

High-risk plaque

HTN:

Hypertension

LEVF:

Left ventricular ejection fraction

LGE:

Late gadolinium enhancement

LHIS:

Lipomatous hypertrophy of the interatrial septum

LV:

Left ventricle

METS:

Metabolic equivalents

MI:

Myocardial infarction

MIP:

Maximum intensity projection

MPI:

Myocardial perfusion imaging

MRI:

Magnetic resonance imaging

MSKCC:

Memorial Sloan-Kettering Cancer Center

MUGA:

Multigated acquisition

NCI:

National Cancer Institute, National Institutes of Health of the United States

PET:

Positron emission tomography

PET/CT:

Positron emission tomography/computed tomography

P-POSSUM:

Predicted mortality-physiologic and operative severity score

RCRI:

Revised cardiovascular risk index

RCRS:

Revised cardiac risk score

RVG:

Radionuclide ventriculography

SEER:

Surveillance, Epidemiology, and End Results

SPECT:

Single-photon emission computed tomography

SUV:

Standardized uptake value

TEE:

Transesophageal echocardiography

VEGF:

Vascular endothelial growth factor

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Authors and Affiliations

  1. Molecular Imaging and Therapy Service, Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Josef J. Fox

  2. Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    H. William Strauss

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  1. Josef J. Fox
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  2. H. William Strauss
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Editors and Affiliations

  1. Nuclear Medicine Unit Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy

    Duccio Volterrani

  2. Nuclear Medicine Unit Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy

    Paola A. Erba

  3. Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    H. William Strauss

  4. Nuclear Medicine Unit Department of Translational Research and Advanced Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy

    Giuliano Mariani

  5. Molecular Imaging and Targeted Therapy Service Department of Radiology, Sloan Kettering Institute, New York, NY, USA

    Steven M. Larson

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Fox, J.J., Strauss, H.W. (2022). Imaging the Cardiovascular System in the Cancer Patient. In: Volterrani, D., Erba, P.A., Strauss, H.W., Mariani, G., Larson, S.M. (eds) Nuclear Oncology. Springer, Cham. https://doi.org/10.1007/978-3-031-05494-5_29

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  • DOI: https://doi.org/10.1007/978-3-031-05494-5_29

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