Современные инструментальные методы диагностики и оценки риска развития кардиоваскулотоксичности противоопухолевой терапии

Важнейшим компонентом кардиоонкологии являются оценка риска развития и диагностика кардиоваскулотоксичности проводимой противоопухолевой терапии, выявление которой во многом базируется на методах визуализации сердечно-сосудистой системы. В статье анализируются современные методы неинвазивной визуализации сердца и сосудов, согласно Клиническим рекомендациям по кардиоонкологии Европейского общества кардиологов 2022 г. Кроме того, обсуждаются перспективные кардиоваскулярные методики визуализации, еще не вошедшие в рекомендации: оценка коронарного кальция с помощью мультиспиральной компьютерной томографии, использование позитронной эмиссионной компьютерной томографии с 18F-меченной 2‑дезокси-2‑фтор-d-глюкозой.

1. Lyon AR, López-Fernández T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J et al. 2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS)): Developed by the task force on cardio-oncology of the European Society of Cardiology (ESC). European Heart Journal. 2022;43(41):4229-361. https://doi.org/10.1093/eurheartj/ehac244

2. Crea F. The complex interaction between cancer, ischaemic heart disease, and heart failure, and a focus on arrhythmias including risk stratification in Brugada syndrome and leadless pacing. European Heart Journal. 2024;45(14):1183-7. https://doi.org/10.1093/eurheartj/ehae197

3. Herrmann J, Lenihan D, Armenian S, Barac A, Blaes A, Cardinale D et al. Defining cardiovascular toxicities of cancer therapies: an International Cardio-Oncology Society (IC-OS) consensus statement. European Heart Journal. 2022;43(4):280-99. https://doi.org/10.1093/eurheartj/ehab674

4. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA: A Cancer Journal for Clinicians. 2021;71(3):209-49. https://doi.org/10.3322/caac.21660

5. Luna-Alcala S, Espejel-Guzmán A, Lerma C, Leon P, Guerra EC, Fernández JRE et al. Heart rate variability-based prediction of early cardiotoxicity in breast-cancer patients treated with anthracyclines and trastuzumab. Cardio-Oncology. 2024;10(1):32. https://doi.org/10.1186/s40959-024-00236-y

6. Lancellotti P, Suter TM, López-Fernández T, Galderisi M, Lyon AR, Van Der Meer P et al. Cardio-Oncology Services: rationale, organization, and implementation. European Heart Journal. 2019;40(22):1756-63. https://doi.org/10.1093/eurheartj/ehy453

7. Lyon AR, Dent S, Stanway S, Earl H, Brezden-Masley C, Cohen-Solal A et al. Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a position statement and new risk assessment tools from the Cardio-Oncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International Cardio-Oncology Society. European Journal of Heart Failure. 2020;22(11):1945-60. https://doi.org/10.1002/ejhf.1920

8. Plana JC, Thavendiranathan P, Bucciarelli-Ducci C, Lancellotti P. Multi-Modality Imaging in the Assessment of Cardiovascular Toxicity in the Cancer Patient. JACC: Cardiovascular Imaging. 2018;11(8):1173-86. https://doi.org/10.1016/j.jcmg.2018.06.003

9. De Azambuja E, Procter MJ, Van Veldhuisen DJ, Agbor-Tarh D, Metzger-Filho O, Steinseifer J et al. Trastuzumab-Associated Cardiac Events at 8 Years of Median Follow-Up in the Herceptin Adjuvant Trial (BIG 1-01). Journal of Clinical Oncology. 2014;32(20):2159-65. https://doi.org/10.1200/JCO.2013.53.9288

10. Карданова С.А., Ильгисонис И.С., Ершов В.И., Привалова Е.В., Беленков Ю.Н. Особенности сердечно-сосудистого статуса и внутрисердечной гемодинамики у больных множественной миеломой до начала противоопухолевой терапии. Кардиология, 2022;62(2):4-11. https://doi.org/10.18087/cardio.2022.2.n1868

11. Curigliano G, Lenihan D, Fradley M, Ganatra S, Barac A, Blaes A et al. Management of cardiac disease in cancer patients throughout oncological treatment: ESMO consensus recommendations. Annals of Oncology. 2020;31(2):171-90. https://doi.org/10.1016/j.annonc.2019.10.023

12. Fawzy AA, El-Menyawi KA, Sallam WM, Zahran ME. Two-dimensional speckle tracking echocardiography in chemotherapy-induced cardiotoxicity in females with breast cancer. Cardio-Oncology. 2024;10(1):13. https://doi.org/10.1186/s40959-024-00209-1

13. Rossello X, Dorresteijn JA, Janssen A, Lambrinou E, Scherrenberg M, Bonnefoy-Cudraz E et al. Risk prediction tools in cardiovascular disease prevention: A report from the ESC Prevention of CVD Programme led by the European Association of Preventive Cardiology (EAPC) in collaboration with the Acute Cardiovascular Care Association (ACCA) and the Association of Cardiovascular Nursing and Allied Professions (ACNAP). European Journal of Cardiovascular Nursing. 2019;18(7):534-44. https://doi.org/10.1177/1474515119856207

14. Čelutkienė J, Plymen CM, Flachskampf FA, De Boer RA, Grapsa J, Manka R et al. Innovative imaging methods in heart failure: a shifting paradigm in cardiac assessment. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure. 2018;20(12):1615-33. https://doi.org/10.1002/ejhf.1330

15. Čelutkienė J, Pudil R, López-Fernández T, Grapsa J, Nihoyannopoulos P, Bergler-Klein J et al. Role of cardiovascular imaging in cancer patients receiving cardiotoxic therapies: a position statement on behalf of the Heart Failure Association (HFA), the European Association of Cardiovascular Imaging (EACVI) and the Cardio-Oncology Council of the European Society of Cardiology (ESC). European Journal of Heart Failure. 2020;22(9):1504-24. https://doi.org/10.1002/ejhf.1957

16. Kalam K, Otahal P, Marwick TH. Prognostic implications of global LV dysfunction: a systematic review and meta-analysis of global longitudinal strain and ejection fraction. Heart. 2014;100(21):1673-80. https://doi.org/10.1136/heartjnl-2014-305538

17. Baron T, Berglund L, Hedin E-M, Flachskampf FA. Test-retest reliability of new and conventional echocardiographic parameters of left ventricular systolic function. Clinical Research in Cardiology. 2019;108(4):355-65. https://doi.org/10.1007/s00392-018-1363-7

18. Lambert J, Lamacie M, Thampinathan B, Altaha MA, Esmaeilzadeh M, Nolan M et al. Variability in echocardiography and MRI for detection of cancer therapy cardiotoxicity. Heart. 2020;106(11):817-23. https://doi.org/10.1136/heartjnl-2019-316297

19. Thavendiranathan P, Negishi T, Coté M-A, Penicka M, Massey R, Cho G-Y et al. Single Versus Standard Multiview Assessment of Global Longitudinal Strain for the Diagnosis of Cardiotoxicity During Cancer Therapy. JACC: Cardiovascular Imaging. 2018;11(8):1109-18. https://doi.org/10.1016/j.jcmg.2018.03.003

20. 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. European Heart Journal Cardiovascular Imaging. 2014;15(3):324-31. https://doi.org/10.1093/ehjci/jet159

21. Thavendiranathan P, Poulin F, Lim K-D, Plana JC, Woo A, Marwick TH. Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy: a systematic review. Journal of the American College of Cardiology. 2014;63(25 Pt A):2751-68. https://doi.org/10.1016/j.jacc.2014.01.073

22. Oikonomou EK, Kokkinidis DG, Kampaktsis PN, Amir EA, Marwick TH, Gupta D et al. Assessment of Prognostic Value of Left Ventricular Global Longitudinal Strain for Early Prediction of Chemotherapy-Induced Cardiotoxicity: A Systematic Review and Meta-analysis. JAMA Cardiology. 2019;4(10):1007-18. https://doi.org/10.1001/jamacardio.2019.2952

23. Plana JC, Galderisi M, Barac A, Ewer MS, Ky B, Scherrer-Crosbie M et al. 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. European Heart Journal Cardiovascular Imaging. 2014;15(10):1063-93. https://doi.org/10.1093/ehjci/jeu192

24. Farsalinos KE, Daraban AM, Ünlü S, Thomas JD, Badano LP, Voigt J-U. Head-to-Head Comparison of Global Longitudinal Strain Measurements among Nine Different Vendors: the EACVI/ASE inter-vendor comparison study. Journal of the American Society of Echocardiography. 2015;28(10):1171-1181.e2. https://doi.org/10.1016/j.echo.2015.06.011

25. Tadic M, Genger M, Cuspidi C, Belyavskiy E, Frydas A, Dordevic A et al. Phasic Left Atrial Function in Cancer Patients Before Initiation of Anti-Cancer Therapy. Journal of Clinical Medicine. 2019;8(4):421. https://doi.org/10.3390/jcm8040421

26. Tocchetti CG, Ameri P, De Boer RA, D’Alessandra Y, Russo M, Sorriento D et al. Cardiac dysfunction in cancer patients: beyond direct cardiomyocyte damage of anticancer drugs: novel cardio-oncology insights from the joint 2019 meeting of the ESC Working Groups of Myocardial Function and Cellular Biology of the Heart. Cardiovascular Research. 2020;116(11):1820-34. https://doi.org/10.1093/cvr/cvaa222

27. Салахеева Е.Ю., Соколова И.Я., Ляпидевская О.В., Жбанов К.А., Цацурова С.А., Каневский Н.И. и др. Оценка структуры и функции левого предсердия у больных лимфопролиферативными заболеваниями на фоне проведения полихимиотерапии: одноцентровое наблюдательное исследование. Рациональная Фармакотерапия в Кардиологии. 2022;18(4):385-92. https://doi.org/10.20996/1819-6446-2022-08-02

28. Салахеева Е.Ю., Щендрыгина А.А., Соколова И.Я., Жбанов К.А., Цацурова С.А., Каневский Н.И. и др. Взаимосвязь уровня С-реактивного белка и параметров функционального состояния левого предсердия у пациентов с лимфопролиферативными заболеваниями на фоне программной химиотерапии. Клиническая медицина. 2023;101(1):55-62. https://doi.org/10.30629/0023-2149-2023-101-1-55-62

29. Sugimoto T, Robinet S, Dulgheru R, Bernard A, Ilardi F, Contu L et al. Echocardiographic reference ranges for normal left atrial function parameters: results from the EACVI NORRE study. European Heart Journal - Cardiovascular Imaging. 2018;19(6):630-8. https://doi.org/10.1093/ehjci/jey018

30. Omidi A, Weiss E, Trankle CR, Rosu-Bubulac M, Wilson JS. Quantitative assessment of radiotherapy-induced myocardial damage using MRI: a systematic review. Cardio-Oncology. 2023;9(1):24. https://doi.org/10.1186/s40959-023-00175-0

31. Guha A, Fradley MG, Dent SF, Weintraub NL, Lustberg MB, Alonso A et al. Incidence, risk factors, and mortality of atrial fibrillation in breast cancer: a SEER-Medicare analysis. European Heart Journal. 2022;43(4):300-12. https://doi.org/10.1093/eurheartj/ehab745

32. Chu G, Versteeg HH, Verschoor AJ, Trines SA, Hemels MEW, Ay C et al. Atrial fibrillation and cancer - An unexplored field in cardiovascular oncology. Blood Reviews. 2019;35:59-67. https://doi.org/10.1016/j.blre.2019.03.005

33. Hundley WG, Bluemke DA, Finn JP, Flamm SD, Fogel MA, Friedrich MG et al. ACCF/ACR/AHA/NASCI/SCMR 2010 Expert Consensus Document on Cardiovascular Magnetic Resonance: A Report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. Circulation. 2010;121(22):2462-508. https://doi.org/10.1161/CIR.0b013e3181d44a8f

34. Fallah-Rad N, Lytwyn M, Fang T, Kirkpatrick I, Jassal DS. Delayed contrast enhancement cardiac magnetic resonance imaging in trastuzumab induced cardiomyopathy. Journal of Cardiovascular Magnetic Resonance. 2008;10(1):5. https://doi.org/10.1186/1532-429X-10-5

35. Galderisi M, Cosyns B, Edvardsen T, Cardim N, Delgado V, Di Salvo G et al. Standardization of adult transthoracic echocardiography reporting in agreement with recent chamber quantification, diastolic function, and heart valve disease recommendations: an expert consensus document of the European Association of Cardiovascular Imaging. European Heart Journal - Cardiovascular Imaging. 2017;18(12):1301-10. https://doi.org/10.1093/ehjci/jex244

36. Patel S, Franco FX, McDonald M, Rivera C, Perez-Villa B, Collier P et al. Use of computed tomography coronary calcium score for prediction of cardiovascular events in cancer patients: a retrospective cohort analysis. Cardio-Oncology. 2024;10(1):1. https://doi.org/10.1186/s40959-023-00196-9

37. Whitlock MC, Yeboah J, Burke GL, Chen H, Klepin HD, Hundley WG. Cancer and Its Association With the Development of Coronary Artery Calcification: An Assessment From the Multi-Ethnic Study of Atherosclerosis. Journal of the American Heart Association. 2015;4(11):e002533. https://doi.org/10.1161/JAHA.115.002533

38. Leiva O, AbdelHameid D, Connors JM, Cannon CP, Bhatt DL. Common Pathophysiology in Cancer, Atrial Fibrillation, Atherosclerosis, and Thrombosis. JACC: CardioOncology. 2021;3(5):619-34. https://doi.org/10.1016/j.jaccao.2021.08.011

39. Yao C, Veleva T, Scott L, Cao S, Li L, Chen G et al. Enhanced Cardiomyocyte NLRP3 Inflammasome Signaling Promotes Atrial Fibrillation. Circulation. 2018;138(20):2227-42. https://doi.org/10.1161/CIRCULATIONAHA.118.035202

40. Freisling H, Viallon V, Lennon H, Bagnardi V, Ricci C, Butterworth AS et al. Lifestyle factors and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study. BMC Medicine. 2020;18(1):5. https://doi.org/10.1186/s12916-019-1474-7

41. Becker MMC, Arruda GFA, Berenguer DRF, Buril RO, Cardinale D, Brandão SCS. Anthracycline cardiotoxicity: current methods of diagnosis and possible role of 18F-FDG PET/CT as a new biomarker. Cardio-Oncology. 2023;9(1):17. https://doi.org/10.1186/s40959-023-00161-6

42. Borde C, Kand P, Basu S. Enhanced myocardial fluorodeoxyglucose uptake following Adriamycin-based therapy: Evidence of early chemotherapeutic cardiotoxicity? World Journal of Radiology. 2012;4(5):220. https://doi.org/10.4329/wjr.v4.i5.220

43. Brandão SCS, Ramos J de OX, de Arruda GFA, Godoi ETAM, Carreira LCTF, Lopes RW et al. Mapping COVID-19 functional sequelae: the perspective of nuclear medicine. American Journal of Nuclear Medicine and Molecular Imaging. 2020;10(6):319-33. PMID: 33329934

44. Vlachopoulos CV, Koutagiar IP, Georgakopoulos AT, Pouli AG, Sioni AΚ, Giannouli SΕ et al. Lymphoma Severity and Type Are Associated With Aortic FDG Uptake by 18F-FDG PET/CT Imaging. JACC: CardioOncology. 2020;2(5):758-70. https://doi.org/10.1016/j.jaccao.2020.11.001

45. Bauckneht M, Ferrarazzo G, Fiz F, Morbelli S, Sarocchi M, Pastorino F et al. Doxorubicin Effect on Myocardial Metabolism as a Prerequisite for Subsequent Development of Cardiac Toxicity: A Translational 18F-FDG PET/CT Observation. Journal of Nuclear Medicine. 2017;58(10):1638-45. https://doi.org/10.2967/jnumed.117.191122

46. Sarocchi M, Bauckneht M, Arboscello E, Capitanio S, Marini C, Morbelli S et al. An increase in myocardial 18-fluorodeoxyglucose uptake is associated with left ventricular ejection fraction decline in Hodgkin lymphoma patients treated with anthracycline. Journal of Translational Medicine. 2018;16(1):295. https://doi.org/10.1186/s12967-018-1670-9