Nuclear Medicine Imaging and Cardiotoxicity

Cardiotoxicity represents a frequent complication secondary to the intake of some classes of chemotherapeutic agents, with significant consequences on patients' outcome. The majority of studies on cardiotoxicity focus on patients treated with anthracyclines and trastuzumab, but cardiotoxic effect has been described for classes of drugs such as inhibitors of tyrosine kinases, inhibitors of vascular endothelial growth factor or multikinase inhibitors (imatinib, dasatinib, nilotinib, sunitinib, sorafenib, and bevacizumab), antimetabolites (5-fluorouracil), alkylating agents (cisplatin, cyclophosphamide), and taxanes (docetaxel and paclitaxel). Radiotherapy (RT), that is often associated with standard chemotherapy treatment, is also associated with cardiotoxicity appearing as (acute) myocardial infarction, pericardial disease, valvular heart disease, and heart failure. The incidence of late irradiation-induced cardiac disease depends on the irradiated volume, total irradiation dose, dose per fraction, and on the presence or absence of preexisting cardiovascular risk factors. Irradiation of the mediastinum with a cumulative dose >30. Gy and a daily fractioning >2. Gy appeared to be related to a high risk of developing cardiac dysfunction. Two groups of patients, i.e., those suffering from Hodgkin's disease and breast cancer, are particularly at risk of developing late myocardial damage, since RT treatment techniques for both patient groups may include (large) parts of the heart, and adjuvant systemic therapy, in particular anthracycline-containing chemotherapy, is frequently administered to these patient.