Thaís Rossato Arrais1,2, Germano Dallegrave Cavalli3, Bárbara Tietbohl Dos Santos4, Gabriela Bartzen Pereira5, Celina Borges Migliavaca6, Gabriel Blacher Grossman7, Andréia Biolo8,3. 1. Nuclear Medicine Department, Hospital Moinhos de Vento, Rua Ramiro Barcelos, 910-201, Porto Alegre, RS, 90035-001, Brazil. thaisarrais@hotmail.com. 2. Post-graduate Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. thaisarrais@hotmail.com. 3. Cardiology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. 4. Psychiatry Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil. 5. Internal Medicine Department, Santa Casa de Porto Alegre, Porto Alegre, Brazil. 6. Post-graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. 7. Nuclear Medicine Department, Hospital Moinhos de Vento, Rua Ramiro Barcelos, 910-201, Porto Alegre, RS, 90035-001, Brazil. 8. Post-graduate Program in Cardiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Abstract
BACKGROUND: Advances in diagnosis and treatment of cancer has improved survival but resulted in increased cardiotoxic effects. The decrease in left ventricular ejection fraction (EF), one of the pillars of diagnosis of cardiotoxicity, seems to be a late process in the evolution of the disease, so 123I-metaiodobenzylguanidine (MIBG) cardiac imaging has been proposed to detect early cardiac impairment. The aim of this systematic review was to evaluate the performance of MIBG cardiac scan in this scenario. METHODS AND RESULTS: A systematic search was conducted in five international databases comparing MIBG parameters with EF for evaluation of cardiotoxicity. Twelve studies were included and separated in three groups. First, studies evaluating patients with established cardiotoxicity, in which EF was reduced and MIBG parameters were abnormal. Second, studies analyzing patients during or after treatment compared to controls, with MIBG parameters significantly different between groups in most studies, even when EF remained normal. Finally, studies analyzing anthracycline (ATC) dose-related changes, with alteration in MIBG parameters occurring even when EF was preserved. CONCLUSION: Although studies had high methodological variability, cardiac sympathetic innervation imaging seems to be a promising tool for assessing early cardiotoxicity. Further studies are needed to analyze its diagnostic value in this scenario.
BACKGROUND: Advances in diagnosis and treatment of cancer has improved survival but resulted in increased cardiotoxic effects. The decrease in left ventricular ejection fraction (EF), one of the pillars of diagnosis of cardiotoxicity, seems to be a late process in the evolution of the disease, so 123I-metaiodobenzylguanidine (MIBG) cardiac imaging has been proposed to detect early cardiac impairment. The aim of this systematic review was to evaluate the performance of MIBG cardiac scan in this scenario. METHODS AND RESULTS: A systematic search was conducted in five international databases comparing MIBG parameters with EF for evaluation of cardiotoxicity. Twelve studies were included and separated in three groups. First, studies evaluating patients with established cardiotoxicity, in which EF was reduced and MIBG parameters were abnormal. Second, studies analyzing patients during or after treatment compared to controls, with MIBG parameters significantly different between groups in most studies, even when EF remained normal. Finally, studies analyzing anthracycline (ATC) dose-related changes, with alteration in MIBG parameters occurring even when EF was preserved. CONCLUSION: Although studies had high methodological variability, cardiac sympathetic innervation imaging seems to be a promising tool for assessing early cardiotoxicity. Further studies are needed to analyze its diagnostic value in this scenario.
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