Tales from the future-nuclear cardio-oncology, from prediction to diagnosis and monitoring

Cancer and cardiovascular diseases (CVD) often share common risk factors, and patients with CVD who develop cancer are at high risk of experiencing major adverse cardiovascular events. Additionally, cancer treatment can induce short- and long-term adverse cardiovascular events. Given the improvement in oncological patients' prognosis, the burden in this vulnerable population is slowly shifting towards increased cardiovascular mortality. Consequently, the field of cardio-oncology is steadily expanding, prompting the need for new markers to stratify and monitor the cardiovascular risk in oncological patients before, during, and after the completion of treatment. Advanced non-invasive cardiac imaging has raised great interest in the early detection of CVD and cardiotoxicity in oncological patients. Nuclear medicine has long been a pivotal exam to robustly assess and monitor the cardiac function of patients undergoing potentially cardiotoxic chemotherapies. In addition, recent radiotracers have shown great interest in the early detection of cancer-treatment-related cardiotoxicity. In this review, we summarize the current and emerging nuclear cardiology tools that can help identify cardiotoxicity and assess the cardiovascular risk in patients undergoing cancer treatments and discuss the specific role of nuclear cardiology alongside other non-invasive imaging techniques

Cardiac denervation evidenced by MIBG occurs earlier than amyloid deposits detection by Diphosphonates scintigraphy in patients with aTTR-FAP

International audienc

Cardiac denervation evidenced by MIBG occurs earlier than amyloid deposits detection by Diphosphonates scintigraphy in patients with aTTR-FAP

International audienc

Multi-modality imaging in cardiac ATTR familial amyloidosis: agreement between echocardiography, MRI and DPD-scintigraphy

From First European Congress on Hereditary ATTR amyloidosisParis, France. 2-3 November 2015International audienceBackgroundThree main imaging techniques are commonly used to identify cardiac transthyretin (ATTR) amyloidosis: echocardiography, MRI and DPD scintigraphy. Each one provides specific diagnostic and prognostic informations but also has its specific limitations. We sought to evaluate a multimodality imaging strategy to diagnose cardiac amyloidosis in ATTR.MethodsSeventy seven consecutive patients with multimodality imaging evaluation (echocardiography, 1.5T MRI and 99mTc-DPD scintigraphy) to diagnose cardiac amyloidosis were identified from the database of the French National Reference Center for Amyloidosis. Patients with pacemaker or severe renal failure did not undergo cardiac MRI and were analyzed on the basis of the echocardiography and scintigraphy (n=17). Three groups were compared: patients with positive agreement to diagnose cardiac ATTR (PA-ATTR group), patients with positive agreement to exclude cardiac ATTR (PA-normal) and patients with negative agreement (NA).ResultsThe mean age was 52 years [44-70]; 59% were male. Transthyretin mutations were Val30Met in 67%, other in 21%, and 12% had acquired ATTR from previous domino liver transplantation; 30 patients had a positive echocardiography, 37 positive MRI and 36 positive DPD scintigraphy. Positive imaging agreement was encountered in 50/77 patients (65%: 30 PA-ATTR and 20 PA-normal). Negative agreement was observed in 27/77 patients (35%). Compared with PA-ATTR patients, NA patients were younger (68 [64-72] years vs. 46 [41-64], had lower BNP levels (149 [94-248] pg/ml vs. 40 [25-102],) and thinner interventricular septum (17 [14-20] mm vs. 12 [10-14]), all p values <0.0001). The two main causes for negative agreement between techniques was the sole positivity of the MRI (n=10) and the sole negativity of the DPD scintigraphy(n=6). Compared with PA-ATTR patients, patients with a sole MRI positivity were younger (41 [39-44] years vs. 68 [64-72] p<0.001), more frequently women (80% vs.26% p=0,002), had thinner interventricular septum (9 [8-11] mm vs.17 [14-20], p<0.0001), had lower BNP levels (26 [24-36] vs 149 [92-249] p<0.0001) and had less diffuse late gadolinium enhancement pattern (10% vs. 66% patients; p<0.0001). As compared with PA-ATTR patients, patients with a sole negativity of the DPD scintigraphy had acquired ATTR from domino liver transplantation in all but one case (83% vs. 6% patients; p=0.02).ConclusionsIn transthyretin amyloidosis, the agreement between echocardiography, cardiac MRI and DPD scintigraphy to diagnose cardiac amyloidosis was observed in 65% of patients. Patients without agreement between these three techniques had distinct patterns of cardiac involvement: sole positivity of the MRI was encountered in patients in the early stages of ATTR; patients with acquired ATTR due to domino liver transplantation often had negative DPD scintigraphy

Exposure duration to mutated TTR is a key parameter determining diphosphonates cardiac uptake in FAP

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Tales from the future—nuclear cardio-oncology, from prediction to diagnosis and monitoring

International audienceAbstract Cancer and cardiovascular diseases (CVD) often share common risk factors, and patients with CVD who develop cancer are at high risk of experiencing major adverse cardiovascular events. Additionally, cancer treatment can induce short- and long-term adverse cardiovascular events. Given the improvement in oncological patients’ prognosis, the burden in this vulnerable population is slowly shifting towards increased cardiovascular mortality. Consequently, the field of cardio-oncology is steadily expanding, prompting the need for new markers to stratify and monitor the cardiovascular risk in oncological patients before, during, and after the completion of treatment. Advanced non-invasive cardiac imaging has raised great interest in the early detection of CVD and cardiotoxicity in oncological patients. Nuclear medicine has long been a pivotal exam to robustly assess and monitor the cardiac function of patients undergoing potentially cardiotoxic chemotherapies. In addition, recent radiotracers have shown great interest in the early detection of cancer-treatment-related cardiotoxicity. In this review, we summarize the current and emerging nuclear cardiology tools that can help identify cardiotoxicity and assess the cardiovascular risk in patients undergoing cancer treatments and discuss the specific role of nuclear cardiology alongside other non-invasive imaging techniques.</jats:p

Relationship between cardiac microvascular dysfunction measured with 82Rubidium-PET and albuminuria in patients with diabetes mellitus

International audienceBackgroundAlbuminuria is of one the strongest predictors of cardiovascular disease (CVD) in diabetes. Diabetes is associated with cardiac microvascular dysfunction (CMD), a powerful, independent prognostic factor for cardiac mortality. The aim of this study was to evaluate the relationship between CMD and microvascular complications in patients without known CVD.MethodsIn this monocentric study, myocardial flow reserve (MFR) was measured with cardiac 82Rubidium positron emission tomography (Rb-PET) in 311 patients referred to nuclear medicine department of Bichat University Hospital for screening of coronary artery disease from 2012 to 2014. Patients with hemodynamically relevant stenosis on coronary angiography or myocardial ischemia on Rb-PET were excluded. Among patients with diabetes, MFR values were compared according to the presence of retinopathy and albuminuria.ResultsOverall, 175 patients (118 with type 2 diabetes) were included. MFR was significantly lower in patients with diabetes compared with those without diabetes (2.6 ± 1.1 vs. 3.3 ± 1.7; p < 0.005). In patients with diabetes, MFR decreased progressively in relation to albumin urinary excretion (normoalbuminuria: 2.9 ± 1.1, microalbuminuria: 2.3 ± 1.0, macroalbuminuria: 1.8 ± 0.7; p < 0.0001). MFR was not significantly different in patients with vs. without retinopathy (2.4 ± 1.0 vs. 2.7 ± 1.1, p = 0.07). Microalbuminuria and macroalbuminuria remained strongly associated with impaired MFR after multiple adjustments [odds ratio 2.6 (95% CI 1.1–8.4) and 5.3 (95% CI 1.2–44.7), respectively]. This association was confirmed when analyses were restricted to patients with low levels of coronary calcifications on computed tomography.ConclusionsImpaired MFR was more frequent in patients with diabetes and was strongly associated with the degree of albuminuria suggesting that CMD and albuminuria might share common mechanisms