Late gadolinium enhancement CMR for detecting myocardial injury after cancer therapy: a real-world observational study

Background Clinically, cardiotoxicity defined by reduced left ventricle ejection fraction (LVEF) in cancer therapy could miss the onset of tissue-level myocardial changes. In this study, we aimed to use late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) to evaluate myocardial injury in patients receiving cancer therapy, and to investigate the effect of LGE and other clinical factors on LV function. Methods This study included 108 cancer patients and 60 healthy controls examined by CMR imaging. Patients were assigned to the LGE-negative (LGE−, n = 80) and LGE-positive groups (LGE+, n = 28). The LV functional parameters and myocardial strain parameters, were compared among the three subgroups. Associations between variables were evaluated via Pearson or Spearman correlation analyses. Further, the association between risk factors and LVEF was determined via multivariate linear regression analysis. Results The LVEF and peak strain (PS) in all directions were significantly lower in the patients with LGE than in those without (all p < 0.05). There were moderate to high correlations between circumferential peak diastolic strain rate (PDSR), peak systolic strain rate (PSSR), PS, and LVEF in the patients with cancer ( r = 0.54, r = −0.63, r = 0.82, respectively; p < 0.001). Multivariate linear regression analysis revealed independent associations between 1) N-terminal-pro B-type natriuretic peptide and radial, circumferential and longitudinal PS ( β = −0.419, β = 0.407, β = 0.327, respectively; p < 0.001), 2) troponin T and circumferential PDSR ( β = 0.342, p < 0.001) and between 3) the LGE extent (LGE%, 5SD) and circumferential PS ( β = 0.297, p < 0.001). Conclusions The presence of LGE was an important risk factor for LV dysfunction in patients receiving cancer therapy, and the circumferential strain reduction is the predominant mechanism of LV dysfunction.