Relationship of promising methods in the detection of anthracycline-induced cardiotoxicity in breast cancer patients

Purpose It remains challenging to identify patients at risk of anthracycline-induced cardiotoxicity. To better understand the different risk-stratifying approaches, we evaluated 123 I- meta iodobenzylguanidine ( 123 I- m IBG) scintigraphy and its interrelationship with conventional echocardiography, 2D strain imaging and several biomarkers. Methods We performed 123 I- m IBG scintigraphy, conventional and strain echocardiography and biomarker (NT-proBNP, TNF-α, galectin-3, IL-6, troponin I, ST-2 and sFlt-1) assessment in 59 breast cancer survivors 1 year after anthracycline treatment. Interobserver and intermethod variability was calculated on planar and SPECT 123 I- m IBG scintigraphy, using the heart/mediastinum (H/M) ratio and washout (WO). Pearson’s r and multivariate analyses were performed to identify correlations and independent predictors of 123 I- m IBG scintigraphy results. Results Delayed planar anterior whole-heart ROI (WH) H/M ratios and WO were the most robust 123 I- m IBG parameters. Significant correlations were observed between 123 I- m IBG parameters and several conventional echo parameters, global longitudinal and radial strain (GLS and GRS) and galectin-3. The highest Pearson’s r was observed between delayed H/M ratio and GRS (Pearson’s r 0.36, p = 0.01). Multivariate analysis showed that GRS was the only independent predictor of the delayed WH H/M ratio ( p = 0.023). Conclusion The delayed planar H/M ratio is the most robust 123 I- m IBG parameter. It correlates with several conventional echocardiographic parameters, GLS, GRS and galectin-3. Of these, only GRS predicts the H/M ratio.