title: Cardiac magnetic resonance imaging for the assessment of the myocardium after doxorubicin-based chemotherapy.
abstract: OBJECTIVE
  Doxorubicin is associated with a cumulative dose-dependent nonischemic cardiomyopathy. Cardiac magnetic resonance imaging (cMRI) is able to examine both structural and functional components of the myocardium. Our aim was to assess the myocardial changes in non-Hodgkin lymphoma patients undergoing doxorubicin-based chemotherapy using cMRI.
  
  
  METHODS
  cMRI examination was performed before and 3 months after chemotherapy. Experienced investigators interpreted each cMRI, and were blinded to all data. Left ventricular ejection fractions (LVEF), cardiac deformation, and delayed gadolinium enhancement (GD-DE) were quantified for each cMRI. The change between LVEF, GD-GE, and cardiac deformation parameters were compared between the 2 cMRI studies. A Δ LVEF≥10% was considered clinically relevant. The findings of GD-GE or changes in myocardial strain were analyzed as independent variables.
  
  
  RESULTS
  All 10 patients enrolled received a cumulative dose of doxorubicin of 300 mg/m. A comparison of pretreatment and posttreatment cMRI demonstrated 5 (50%) patients with a ≥10% decrease in LVEF (median, -8.4%; range, 1% to -17%; P=0.004). Three patients had at least 1 new or progressive segment of GD-DE. The global circumferential strain was significantly lower in patients after treatment, as compared with values before treatment (P=0.018) and to normal controls (P=0.046). Patients after treatment also had significantly lower global longitudinal strain than controls (P=0.035), and longitudinal strain values that tended to decrease compared with pretreatment values (P=0.073).
  
  
  CONCLUSIONS
  Our data suggests that cMRI has the ability to assess both early structural and functional myocardial changes in association with doxorubicin-based chemotherapy.
authors.affiliation: Departments of *Internal Medicine, Division of Oncology/Hematology †Pediatrics, Division of Pediatric Cardiology, Children's Hospital and Medical Center, University of Nebraska Medical Center, Omaha, NE.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: Lunning
authors.forename: Shelby
authors.initials: S
authors.lastname: Kutty
authors.forename: Eric T
authors.initials: ET
authors.lastname: Rome
authors.forename: Ling
authors.initials: L
authors.lastname: Li
authors.forename: Asif
authors.initials: A
authors.lastname: Padiyath
authors.forename: Fausto
authors.initials: F
authors.lastname: Loberiza
authors.forename: Robert Gregory
authors.initials: RG
authors.lastname: Bociek
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Bierman
authors.forename: Julie M
authors.initials: JM
authors.lastname: Vose
authors.forename: James O
authors.initials: JO
authors.lastname: Armitage
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Porter
mesh_terms: D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D009202:Cardiomyopathies / Q000139:chemically induced / Q000175:diagnosis*; D066126:Cardiotoxicity; D016022:Case-Control Studies; D003520:Cyclophosphamide / Q000627:therapeutic use; D004317:Doxorubicin / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008224:Lymphoma, Follicular / Q000188:drug therapy*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011241:Prednisone / Q000627:therapeutic use; D011446:Prospective Studies; D000069283:Rituximab; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced / Q000175:diagnosis*; D014750:Vincristine / Q000627:therapeutic use
chemical_list: D000903:Antibiotics, Antineoplastic; D058846:Antibodies, Monoclonal, Murine-Derived; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone