Early detection of myocardial perfusion impairments in cancer patients undergoing polychemotherapy

Abstract

Aim. To study the effects of polychemotherapy (PCT) on the cellular perfusion of the left ventricular myocardium in patients with cancer according to single-photon emission computed tomog.

Material and methods. Gated perfusion single-photon emission computed tomography (SPECT) of the left ventricular (LV) myocardium with systolic and diastolic function assessment was performed in 66 patients with oncological diseases, including 35 patients without prior PCT and 31 patients with a referral for repeated PCT. Myocardial perfusion SPECT was performed before starting PCT and after 4 courses of PCT to assess signs of cardiotoxicity.
Results. In the group of patients with previous PCT and preserved LV systolic function, previously performed antitumor treatment led to the appearance of inhomogeneous myocardial perfusion according to SPECT data in 61.3% of cases. In both groups, current polychemotherapy courses led to more avid diffuse myocardial perfusion impairments, as well as significant impairments of systolic and diastolic function of the left ventricular myocardium (p<0.05). The cumulative dose of doxorubicin >300 mg/m2 was associated with the presence of SPECT signs of LV myocardium cardiotoxicity with a sensitivity of 90.0% and a specificity of 62.5% (AUC 0.77, p <0.01).
Conclusion. The use of myocardial perfusion SPECT in patients undergoing chemotherapy enables identification and quantification of subclinical myocardial damage at the cellular level before the onset of functional disorders.