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Early detection of chemotherapy associated cardiotoxicity in women with breast cancer
Although chemotherapy prolongs survival and reduces tumor burden for women with breast cancer, its use can cause irreversible congestive heart failure (CHF) and death. The most accurate method for detecting chemotherapy induced cardiotoxicity is an intramyocardial biopsy, but this procedure is invasive, relatively expensive, and not well suited for repetitive examinations. A safe, widely available, noninvasive method to detect chemotherapy induced cardiotoxicity would be useful in 2 respects. First, early detection of cardiotoxicity could help prevent the development of CHF, and second, the absence of cardiotoxicity would allow the continuation of therapy so that patients could realize the full benefit of the medication. We provide pilot data indicating that magnetic resonance imaging (MRI) T1 and T2 weighted image data are useful in human subjects for identifying early myocardial injury before the heart sustains a decrement in global performance. Women receiving an anthracycline followed by Herceptin are at an elevated risk for cardiac injury. We hypothesize that our imaging techniques will predict a future drop in LVEF after receipt of Herceptin. The aims of this study are to define the MRI predictors of heart muscle injury in 35 women at high risk for developing cardiac injury due to the receipt of Herceptin. MRI data will be acquired before and during the course of chemotherapy. By deter-mining the MRI predictors of heart injury in women receiving Herceptin chemotherapy, we will obtain the information needed to guide implementation of MRI as a cardiac injury surveillance tool as women receive Herceptin. It is our goal to apply our newly developed cardiac MRI techniques to women receiving chemotherapy in order to reduce the incidence of heart injury and optimize the delivery of therapy for breast cancer patients.
Breast cancer patients who receive chemotherapy exhibit a 2% to 20% risk (1 in 50 to 1 in 5) of developing permanent injury to their heart muscle. This commonly causes congestive heart failure (CHF), a life altering condition in which the heart cannot pump enough blood to the body's other organs. Manifestations of CHF include fluid collection in the lungs and shortness of breath, fatigue, swelling in the legs, and death. In some, the fear of CHF limits the delivery of chemotherapy, and thus inadvertently impacts the efforts of the healthcare community to treat and cure breast cancer. We have developed a non-invasive imaging technique using magnetic resonance imaging (MRI) that can help detect the early development of heart damage (as manifest by a drop in left ventricular ejection fraction [LVEF]) caused by breast cancer chemotherapy. This finding could be useful in 2 respects: first, women without evidence of MRI heart muscle injury could receive the full benefit of their chemotherapeutic regimen without the concern of developing a heart problem. Second, women with early evidence of injury could modify their chemotherapy so as to avoid CHF. It is our hypothesis that MRI can be used to identify early evidence of heart injury before a drop in LVEF occurs. The aim of this proposal is to define MRI predictors of a drop in LVEF in women that receive Herceptin. It is our long-term goal to devise a strategy that uses MRI to prevent CHF in women receiving chemotherapy so that women with breast cancer can be treated most effectively, and the death rate from breast cancer reduced.