Journal of Clinical PracticeJournal of Clinical PracticeКлиническая практика2220-30952618-8627Eco-Vector1077410.17816/clinpract09150-62ReviewsНаучные обзорыReview ArticleMethods of diagnosis in cardio-oncologyКардиоонкология, часть 2. Методы диагностики в кардиоонкологииPlokhovaE. V.ПлоховаЕкатерина Владимировна
Russian Federation

к.м.н, врач-кардиолог кардиологического отделения ФНКЦ ФМБА России

evplokhova@gmail.comSorokinA. V.СорокинАлександр Вячеславович
Russian Federation

врач отделения рентгенхирургических методов диагностики и лечения ФНКЦ ФМБА России

drav40in@gmail.comStaferovA. V.СтаферовАнтон Валерьевич
Russian Federation

к.м.н., заведующий отделением рентгенхирургических методов диагностики и лечения ФНКЦ ФМБА России

avstaferov@mail.ruDunduaD. P.ДундуаДавид Петрович
Russian Federation

д.м.н., руководитель кардиологического центра ФНКЦ ФМБА России

david.doundoua@gmail.comFederal research Clinical center for specialized types of health care and medical technologies of Federal Medical and Biology AgencyФГБУ " Федеральный научно-клинический центр специализированных видов медицинской помощи и медицинских технологий ФМБА России"150320189150622512201825122018Copyright ©; 2018, Plokhova E.V., Sorokin A.V., Staferov A.V., Dundua D.P.Copyright ©; 2018, Плохова Е.В., Сорокин А.В., Стаферов А.В., Дундуа Д.П.2018Plokhova E.V., Sorokin A.V., Staferov A.V., Dundua D.P.Плохова Е.В., Сорокин А.В., Стаферов А.В., Дундуа Д.П.https://creativecommons.org/licenses/by-nc-nd/4.0https://clinpractice.ru/clinpractice/article/view/10774

Early diagnosis and advances in treatment have led to improved survival of patients with cancer, but have also increased morbidity and mortality due to treatment side effects. Cardiovascular diseases (CVDs) are one of the most frequent of these side effects. As a result of the direct effects of radiation therapy and chemotherapy on heart and vessels сan be: acceleration of atherosclerosis, damage of cardiomyocytes and endothelium, and arterial and venous thrombosis. The direct effect of the cancer treatment on the heart is called cardiotoxicity. Early diagnosis and identification of patients at high risk of cardiotoxicity is the first step towards successful prevention of CVD in cancer patients without compromising cancer care, which ultimately leads to a reduction in mortality. Echocardiography is the method of choice for the detection of myocardial dysfunction during and after cancer therapy. New methods of imaging like three-dimensional echocardiography, speckle-tracking echocardiography, cardiac magnetic resonance show a higher sensitivity in detecting of early myocardial dysfunction during cancer therapy. This review outlines the main diagnostic algorithms and approaches used in cardiooncology.

Ранняя диагностика и появление новых методов лечения рака привели к улучшению выживаемости пациентов с онкологическими заболеваниями. Однако, агрессивная терапия, направленная против злокачественного процесса, нередко приводит к новым заболеваниям. К ним, в первую очередь, следует отнести сердечно-сосудистые заболевания (ССЗ). В результате прямого воздействия лучевой терапии и химиотерапии на структуру сердца и сосудов происходит акселерация атеросклероза, поражение кардиомиоцитов и эндотелия, увеличивается склонность к тромбообразованию. Влияние противоопухолевого лечения на сердце разнообразно и наиболее часто определяется как кардиотоксичность.

Своевременная диагностика и выявление пациентов с высоким риском кардиотоксичности является первым шагом на пути к успешной профилактике ССЗ у онкобольных, не ставя под угрозу лечение рака, что в конечном итоге приводит к снижению общей смертности. К основным методам диагностики кардиотоксичности до и после лечения относят двухмерную эхокардиографию. Новые методы визуализации – трехмерная эхокардиография, speckle-tracking эхокардиография и магнитно-резонансная томография, показывают еще более высокую чувствительность при выявлении ранних изменений функции миокарда на фоне проводимой терапии рака. В данной статье рассматриваются основные диагностические алгоритмы и подходы, применяемые в кардиоонкологии.

cardiotoxicityleft ventricular dysfunctionheart failureechocardiographyspeckle-tracking echocardiographyкардиотоксичностьдисфункция левого желудочкасердечная недостаточностьэхокардиографияspeckle-tracking эхокардиографияZamorano J.L., Lancellotti P., Rodriguez Mu oz D., Aboyans V., et al. 2016 ESC Position Paper on cancer treatments and cardiovascular toxicity developed under the auspices of the ESC Committee for Practice Guidelines: The Task Force for cancer treatments and cardiovascular toxicity of the European Society of Cardiology (ESC). Eur. Heart J. – 2016.Fei HW, Ali MT, Tan TC, Cheng KH, Salama L, Hua L, Zeng X, Halpern EF, Taghian A, MacDonald SM, Scherrer-Crosbie M. Left Ventricular Global Longitudinal Strain in HER-2 + Breast Cancer Patients Treated with Anthracyclines and Trastuzumab Who Develop Cardiotoxicity Is Associated with Subsequent Recovery of Left Ventricular Ejection Fraction. Echocardiography. 2016 Apr;33(4):519-26.Mousavi N, Tan TC, Ali M, Halpern EF, Wang L, Scherrer-Crosbie M. Echocardiographic parameters of left ventricular size and function as predictors of symptomatic heart failure in patients with a left ventricular ejection fraction of 50-59% treated with anthracyclines. Eur Heart J Cardiovasc Imaging. 2015 Sep;16(9):977-84.Boyd A, Stoodley P, Richards D, Hui R, Harnett P, Vo K, Marwick T, Thomas L. Anthracyclines induce early changes in left ventricular systolic and diastolic function: A single centre study. PLoS One. 2017 Apr 13;12(4):e0175544.Lange SA, Jung J, Jaeck A, Hitschold T, Ebner B. Subclinical Myocardial Impairment Occurred in Septal and Anterior LV Wall Segments After Anthracycline- Embedded Chemotherapy and did not Worsen During Adjuvant Trastuzumab Treatment in Breast Cancer Patients. Cardiovasc Toxicol. 2016 Apr;16(2):193-206.Ho E, Brown A, Barrett P, Morgan RB, King G, Kennedy MJ, Murphy RT. Subclinical anthracycline- and trastuzumab-induced cardiotoxicity in thelong- term follow-up of asymptomatic breast cancer survivors: a speckle tracking echocardiographic study. Heart. 2010 May;96(9):701-7.Serrano JM, González I, Del Castillo S, Mu iz J, Morales LJ, Moreno F, Jiménez R, Cristóbal C, Graupner C, Talavera P, Curcio A, Martínez P, Guerra JA, Alonso JJ. Diastolic Dysfunction Following Anthracycline-Based Chemotherapy in Breast Cancer Patients: Incidence and Predictors. Oncologist. 2015 Aug;20(8):864-72.Stoodley PW, Richards DA, Boyd A, Hui R, Harnett PR, Meikle SR, Clarke JL, Thomas L. Altered left ventricular longitudinal diastolic function correlates with reduced systolic function immediately after anthracycline chemotherapy. Eur Heart J Cardiovasc Imaging. 2013 Mar;14(3):228-34.Song F, Kang Y, Zhang C, Xu Y, Shi J, Guo Y, Zhang Q, Shu X, Cheng L. The early variation of left ventricular twisting function in patients with lymphoma received anthracycline therapy assessed by three-dimensional speckle tracking echocardiography. Cardiol J. 2017 Mar 29.Tsai HR, Gjesdal O, Wethal T, Haugaa KH, Foss A, Foss SD, Edvardsen T. Left ventricular function assessed by two-dimensional speckle tracking echocardiography in long-term survivors of Hodgkin's lymphoma treated by mediastinal radiotherapy with or without anthracycline therapy. Am J Cardiol. 2011 Feb 1;107(3):472-7.Cardinale D Colombo A Lamantia G Colombo N Civelli M De Giacomi Get al Anthracycline-induced cardiomyopathy clinical relevance and response to pharmacologic therapy. J Am Coll Cardiol 2010;55:213–20.Ewer MS Ali M Mackay B Wallace S Valdivieso M Legha Set al A comparison of cardiac biopsy grades and ejection fraction estimations in patients receiving Adriamycin. J Clin Oncol 1984;2:112–7.Solomon SD Anavekar N Skali H McMurray JJ Swedberg K Yusuf S. et al. Influence of ejection fraction on cardiovascular outcomes in a broad spectrum of heart failure patients. Circulation 2005;112:3738–44.V. Mor-Avi, R.M. Lang, L.P. Badano, et al. Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications Eur J Echocardiogr, 12 (2011), pp. 167-205.Fallah-Rad N, Walker JR, Wassef A, et al. The utility of cardiac biomarkers, tissue velocity and strain imaging, and cardiac magnetic resonance imaging in predicting early left ventricular dysfunction in patients with human epidermal growth factor receptor II-positive breast cancer treated with adjuvant trastuzumab therapy. J Am Coll Cardiol 2011;57:2263-70.Sawaya H, Sebag IA, Plana JC, etal. Earlydetection and prediction of cardiotoxicity in chemotherapy- treated patients. Am J Cardiol 2011;107:1375-80.Thavendiranathan P, Poulin F, Lim KD, et al. Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy: a systematic review. J Am Coll Cardiol 2014;63:2751-68.Negishi K, Negishi T, Hare JL, et al. Independent and incremental value of deformation indices for prediction of trastuzumab-induced cardiotoxicity. J Am Soc Echocardiogr 2013;26:493-8.Sawaya H, Sebag IA, Plana JC, et al. Assessment of echocardiography and biomarkers for the extended prediction of cardiotoxicity in patients treated with anthracyclines, taxanes, and trastuzumab. Circ Cardiovasc Imaging 2012;5:596-603.Australian Government, National Health and Medical Research Council, Department of Industry. Tasmanian Study of Echocardiographic detection of Left ventricular dysfunction (TAS-ELF). Available from: www.australianclinicaltrials. gov.au/node/1716.Cadeddu C, Piras A, Mantovani G, Deidda M, Dessì M, Madeddu C, Massa E, Mercuro G. Protective effects of the angiotensin II receptor blocker telmisartan on epirubicin-induced inflammation, oxidative stress, and early ventricular impairment. Am Heart J. 2010 Sep;160(3):487.e1-7.Plana JC, Galderisi M, Barac A, Ewer MS, Ky B, Scherrer-Crosbie M, Ganame J, Sebag IA, Agler DA, Badano LP, Banchs J, Cardinale D, Carver J, Cerqueira M, DeCara JM, Edvardsen T, Flamm SD, Force T, Griffin BP, Jerusalem G, Liu JE, Magalhaes, Marwick T, Sanchez LY, Sicari R, Villarraga HR, Lancellotti P. Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: a report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2014;15:1063–1093.Tian M Nishijima Y Asp ML Stout MB Reiser PJ Belury MA. Cardiac alterations in cancer-induced cachexia in mice. Int J Oncol 2010;37:347–53.Negishi K, Negishi T, Haluska BA, Hare JL, Plana JC, Marwick TH. Use of speckle strain to assess left ventricular responses to cardiotoxic chemotherapy and cardioprotection. Eur Heart J Cardiovasc Imaging. 2014 Mar;15(3):324-31.Stoodley PW, Richards DA, Hui R, Boyd A, Harnett PR, Meikle SR, Clarke J, Thomas L. Two- dimensional myocardial strain imaging detects changes in left ventricular systolic function immediately after anthracycline chemotherapy. Eur J Echocardiogr. 2011 Dec;12(12):945-52.Song FY, Shi J, Guo Y, Zhang CJ, Xu YC, Zhang QL, Shu XH, Cheng LL. Assessment of biventricular systolic strain derived from the two-dimensional and three-dimensional speckle tracking echocardiography in lymphoma patients after anthracycline therapy. Int J Cardiovasc Imaging. 2017 Jun;33(6):857-868.Mornoş C, Petrescu L. Early detection of anthracycline-mediated cardiotoxicity: the value of considering both global longitudinal left ventricular strain and twist. Can J Physiol Pharmacol. 2013 Aug;91(8):601-7.Motoki H, Koyama J, Nakazawa H, Aizawa K, Kasai H, Izawa A, Tomita T, Miyashita Y, Kumazaki S, Takahashi M, Ikeda U. Torsion analysis in the early detection of anthracycline-mediated cardiomyopathy. Eur Heart J Cardiovasc Imaging. 2012 Jan;13(1):95- 103.Erven K, Florian A, Slagmolen P, Sweldens C, Jurcut R, Wildiers H, Voigt JU, Weltens C. Subclinical cardiotoxicity detected by strain rate imaging up to 14 months after breast radiation therapy. Int J Radiat Oncol Biol Phys. 2013 Apr 1;85(5):1172-8.Tuohinen SS, Skyttд T, Poutanen T, Huhtala H, Virtanen V, Kellokumpu-Lehtinen PL, Raatikainen P. Radiotherapy-induced global and regional differences in early-stage left-sided versus right-sided breast cancer patients: speckle tracking echocardiography study. Int J Cardiovasc Imaging. 2017 Apr;33(4):463-472.Mornoş C, Manolis AJ, Cozma D, Kouremenos N, Zacharopoulou I, Ionac A. The value of left ventricular global longitudinal strain assessed by three- dimensional strain imaging in the early detection of anthracyclinemediated cardiotoxicity. Hellenic J Cardiol. 2014 May-Jun;55(3):235-44.de Geus-Oei L.-F., Mavinkurve-Groothuis A. M. C., Bellersen L., et al. Scintigraphic techniques for early detection of cancer treatment-induced cardiotoxicity. Journal of Nuclear Medicine. 2011;52(4):560–571.Nakata T, Nakajima K, Yamashina S, Yamada T, Momose M, Kasama S, Matsui T, Matsuo S, Travin MI, Jacobson AF. A pooled analysis of multicenter cohort studies of (123)I-mIBG imaging of sympathetic innervation for assessment of long-term prognosis in heart failure. JACC Cardiovasc Imaging. 2013 Jul;6(7):772-84.Panjrath G. S., Jain D. Monitoring chemotherapy- induced cardiotoxicity: role of cardiac nuclear imaging. Journal of Nuclear Cardiology. 2006;13(3):415–426.Wakasugi S, Fischman AJ, Babich JW, Aretz HT, Callahan RJ, Nakaki M, Wilkinson R, Strauss HW. Metaiodobenzylguanidine: evaluation of its potential as a tracer for monitoring doxorubicin cardiomyopathy. J Nucl Med. 1993 Aug;34(8):1283-6.Jeon TJ, Lee JD, Ha JW, Yang WI, Cho SH. Evaluation of cardiac adrenergic neuronal damage in rats with doxorubicin-induced cardiomyopathy using iodine-131 MIBG autoradiography and PGP immunohistochemistry. Eur J Nucl Med. 2000 Jun;27(6):686-93.Niitsu N, Yamazaki J, Umeda M. [Clinical usefulness of 123I-BMIPP (beta-methyl iodophenyl pentadecanoic (acid) myocardial SPECT in patients with hematological malignancies with adriamycin- induced cardiomyopathy]. Gan To Kagaku Ryoho. 1996 Nov;23(13):1793-7.Pennell DJ, Sechtem UP, Higgins CB, Manning WJ, Pohost GM, Rademakers FE, et al. Clinical indications for cardiovascular magnetic resonance (CMR): Consensus Panel report. J Cardiovasc Magn Reson 2004;6:727-65.Armstrong AC, Gidding S, Gjesdal O, Wu C, Bluemke DA, Lima JA. LV mass assessed by echocardiography and CMR, cardiovascular outcomes, and medical practice. JACC Cardiovasc Imaging 2012;5:837-48.Thavendiranathan P., Wintersperger B. J., Flamm S. D., Marwick T. H. Cardiac MRI in the assessment of cardiac injury and toxicity from cancer chemotherapy a systematic review. Circulation: Cardiovascular Imaging. 2013;6(6):1080–1091.Wassmuth R., Lentzsch S., Erdbruegger U., et al. Subclinical cardiotoxic effects of anthracyclines as assessed by magnetic resonance imaging—a pilot study. The American Heart Journal. 2001;141(6):1007–1013.Fallah-Rad N., Lytwyn M., Fang T., Kirkpatrick I., Jassal D. S. Delayed contrast enhancement cardiac magnetic resonance imaging in trastuzumab induced cardiomyopathy. Journal of Cardiovascular Magnetic Resonance. 2008;10.Drafts B. C., Twomley K. M., D'Agostino R., Jr., et al. Low to moderate dose anthracycline-based chemotherapy is associated with early noninvasive imaging evidence of subclinical cardiovascular disease. Journal of the American College of Cardiology: Cardiovascular Imaging. 2013;6(8):877–885.Armstrong G. T., Plana J. C., Zhang N., et al. Screening adult survivors of childhood cancer for cardiomyopathy: comparison of echocardiography and cardiac magnetic resonance imaging. Journal of Clinical Oncology. 2012;30(23):2876–2884.Armstrong AC, Gidding S, Gjesdal O, Wu C, Bluemke DA, Lima JA. LV mass assessed by echocardiography and CMR, cardiovascular outcomes, and medical practice. JACC Cardiovasc Imaging 2012;5:837-48.Cardinale D, Sandri MT, Colombo A, Colombo N, Boeri M, Lamantia G, Civelli M, Peccatori F, Martinelli G, Fiorentini C, Cipolla CM. Prognostic value of troponin I in cardiac risk stratification of cancer patients undergoing high-dose chemotherapy. Circulation. 2004;109(22):2749.Ky B, Putt M, Sawaya H, French B, Januzzi JL Jr, Sebag IA, Plana JC, Cohen V, Banchs J, Carver JR, Wiegers SE, Martin RP, Picard MH, Gerszten RE, Halpern EF, Passeri J, Kuter I, Scherrer-Crosbie M. Early increases in multiple biomarkers predict subsequent cardiotoxicity in patients with breast cancer treated with doxorubicin, taxanes, and trastuzumab. J Am Coll Cardiol. 2014;63(8):809.Brosius FC, 3rd, Waller BF, Roberts WC. Radiation heart disease. Analysis of 16 young (aged 15 to 33 years) necropsy patients who received over 3,500 rads to the heart. Am J Med 1981;70:519–530.Veinot JP, Edwards WD. Pathology of radiation- induced heart disease: A surgical and autopsy study of 27 cases. Hum Pathol 1996;27:766–773.Orzan F, Brusca A, Conte MR, Presbitero P, Figliomeni MC. Severe coronary artery disease after radiation therapy of the chest and mediastinum: Clinical presentation and treatment. Br Heart J 1993;69:496– 500.Rademaker J, Schoder H, Ariaratnam NS, et al. Coronary artery disease after radiation therapy for Hodgkin’s lymphoma: Coronary CT angiography findings and calcium scores in nine asymptomatic patients. AJR Am J Roentgenol 2008;191:32–37.Kupeli S, Hazirolan T, Varan A, et al. Evaluation of coronary artery disease by computed tomography angiography in patients treated for childhood Hodgkin’s lymphoma. J Clin Oncol 2010;28:1025–1030.Taylor CW, Nisbet A, McGale P, Darby SC. Cardiac exposures in breast cancer radiotherapy: 1950s-1990s. Int JRadiat Oncol Biol Phys 2007;69:1484– 1495.Correa CR, Litt HI, Hwang WT, et al. Coronary artery findings after left-sided compared with right- sided radiation treatment for early-stage breast cancer. J Clin Oncol 2007;25:3031–3037.Lee MS, Finch W, Mahmud E. Cardiovascular complications of radiotherapy. Am J Cardiol 2013;112:1688–1696.Tsang TS, Enriquez-Sarano M, Freeman WK, et al. Consecutive 1127 therapeutic echocardiographically guided pericardiocenteses: Clinical profile, practice patterns, and outcomes spanning 21 years. Mayo Clin Proc 2002;77:429–436.Silvestry FE, Kerber RE, Brook MM, et al. Echocardiography guided interventions. J Am Soc Echocardiogr 2009;22:213–231. quiz 316-217.