MRI May Predict Heart Complications After Cancer Treatment

In patients with cancer who were treated with Imbruvica (ibrutinib), myocardial injury (inflammation and fibrosis), was common and the presence was associated with a higher cardiotoxic risk, according to study results.

Imbruvica is often used in patients with leukemia, and it is noted that it may cause an often under-anticipated high risk of cardiac events, explained Dr. Daniel Addison, author on the study and associate professor of medicine and service director of the cardio oncology program at The Ohio State University in Columbous.

“Now, much of this has been balanced against the dramatic benefits of this drug and drugs like it,” he said in an interview with CURE®. “But we know that in a significant number of patients, there's this chance of abnormal heart rhythms and some of these rhythms can be pretty serious.”

Additionally, there are not effective predictors of who these events might affect or when they may occur.

“The purpose of this study was really to test whether we could apply newer techniques like heart MRI, to really see if we could detect changes in the heart, and what these changes would mean, for someone's future risk of heart events,” he added.

The study, which was published in the journal JAMA, included 49 patients who were treated with Imbruvica, including 33 who imaged after treatment radiation. The main goal was to determine the presences of late gadolinium enhancement fibrosis, which is associated with heart attack. A secondary goal was the occurrences of major adverse cardiac events, which included atrial fibrillation, heart failure, symptomatic ventricular arrhythmias, and sudden death of probable or definite Imbruvica association after cardiovascular magnetic resonance.

Results demonstrated that were was no association between traditional cardiovascular disease risk or cancer treatment status and cardiovascular magnetic resonance measures.

Among those without traditional cardiovascular disease risk, 16 (58.6%) had presence of late gadolinium enhancement.

Traditional cardiovascular risk and presence of late gadolinium enhancement were associated with high risks of major adverse cardiac events.

These results mean that patients who have suspected cardiotoxicity from cancer treatment often show abnormal scaring in the heart when they are assessed with heart MRIs.

“This is interesting, because in many of these patients, there often are really no other major changes on other heart assessment techniques, like heart ultrasounds, or echoes, and other tests other than just hopefully catching it on an EKG, or when someone gets a heart monitor,” Addison noted.

The other major finding from the data is that Addison and researchers could observe the heart scaring and inflammation, and those changes could predict future heart events.

“These results are very important for patients because up to this point, we really don't have any techniques to even detect who is going to go on to develop heart issues, or serious heart rhythms with this treatment,” he said. “So this is a dramatic step forward for us to understand, one that we can actually possibly detect changes in the heart and people who we suspect could have heart issues for which there's really no other explanation. And then two it could also predict who will go on to have serious heart troubles in the future.”

Addison recommends that if patients feel like they might be at risk for cardiac events or are having symptoms they should consider asking their provider about additional heart testing.

“If someone feels like they're having heart issues, like feeling their heart's racing, or feeling chest pain, or shortness of breath, they should talk to their cancer provider about getting more heart testing,” he concluded. “And if the heart testing is still not really showing anything clear, and they've already had tests, like an EKG and heart ultrasound, they should be considered for potential heart MRI.”

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