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  • 16 The cardiac toxicity CMR study in patients with lung cancer treated with chemo-radiotherapy: The cart study- a semi quantitative analysis of the myocardial perfusion index

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16 The cardiac toxicity CMR study in patients with lung cancer treated with chemo-radiotherapy: The cart study- a semi quantitative analysis of the myocardial perfusion index
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  1. K Mangion1,
  2. C Berry1,
  3. J Foster1,
  4. S Nowicki2,
  5. N Sattar1,
  6. N O’Rourke2,
  7. M Glegg2,
  8. M Sankaralingham2,
  9. J Paul3,
  10. C Lawless2,
  11. J Stobo3,
  12. N Mohammed2,
  13. A Radjenovic1
  1. 1BHF Glasgow Cardiovascular Research Centre, University of Glasgow, UK
  2. 2The Beatson West of Scotland Cancer Centre, NHS Greater Glasgow and Clyde
  3. 3Cancer Research UK Clinical Trials Unit, Institute of Cancer Sciences, University of Glasgow

Abstract

Background There are limited data on the cardiac effects of radiotherapy and chemo-radiotherapy on the heart in patients with non-small cell lung cancer (NSCLC). CART is a pilot study designed to investigate change in myocardial function and tissue properties where Patients will undergo cardiac magnetic resonance (CMR) at baseline, during treatment, at 6 weeks and at 6 months after treatment completion. Here we report our preliminary findings related to temporal changes in myocardial perfusion index (MPI).

Methods CMR was performed on a Siemens MAGNETOM Verio (Erlangen, Germany) 3.0 Tesla scanner. First-pass myocardial perfusion was assessed by saturation recovery prepared dynamic contrast enhanced sequence during administration of 0.1 mmol/kg of gadoterate meglumine (Dotarem). Semiquantitative analysis was performed on segmented basal and mid-LV short axis slices to derive normalised upslopes of myocardial signal intensity profiles (myocardial perfusion index, MPI). The change in MPI over time was analysed statistically using a linear mixed effects model.

Results 13 patients currently have undergone CMR at baseline and during treatment (mean age 66 years, SD: 9; 71% male),  8 patients have undergone CMR at 6 weeks post treatment initiation (5 patients lost to follow-up/ died), and 6 patients have undergone CMR at 6 months from baseline (n = 2 lost to follow-up/ died). Perfusion index (Figure 1) varies significantly with time (p = 0.0015). After adjustment for multiple testing, the increase from baseline is statistically significant at 6 weeks (p = 0.014) and approaches significance at 6 months (p = 0.074) post treatment.

Conclusion Change in microvascular perfusion is most pronounced 6 weeks following the completion of treatment. This finding will be used in the design of future clinical studies, where measurement of MPI will provide a robust comparison of different existing and emerging treatment protocols for NSCLC with regard to their effects on myocardial physiology.

Funding Beatson Oncology Centre Fund

Abstract 16 Figure 1
Abstract 16 Figure 1

Boxplots of global myocardial perfusion index values by time point

https://doi.org/10.1136/heartjnl-2016-309668.16

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