Subclinical myocardial impairment in treatment-naive cancer patients assessed by cardiac magnetic resonance

Background Functional and myocardial tissue modifications can occur in treatment-naïve cancer patients naive, driven by uncontrolled inflammation and neuro-hormonal activation. These mechanisms may result in myocardial alterations that serve as subclinical imaging markers of potential cardiac dysfunction. Objective This study aims to evaluate the role of cardiac magnetic resonance (CMR) in investigating cancer-associated immune activation and identifying early biomarkers of myocardial damage in treatment-naive cancer patients. Methods This prospective study enrolled 70 participants, including 35 treatment-naive cancer patients (19 breast cancer, 16 DLBCL) and 35 age- and gender-matched healthy controls. All participants underwent comprehensive CMR imaging before starting chemotherapy. Correlation analysis was conducted to identify differences in myocardial tissue characterization and functional parameter between the two groups. Results Native T1 values were significantly elevated in the cancer cohort compared to controls (1013 ± 27 ms vs. 981 ± 31 ms; p < 0.001), while GLS was significantly reduced (-15 ± 2% vs. -22 ± 7%; p < 0.001). Native T2 values showed a marginal increase but did not significantly correlate with GLS. Correlation analysis identified native T1 as an independent predictor of GLS impairment (R = -0.5; p = 0.001). No significant differences in LV mass were observed, suggesting that myocardial tissue changes may precede structural remodeling. Conclusion Treatment-naive cancer patients exhibit subclinical myocardial alterations, characterized by elevated native T1 and reduced GLS. Cardiac magnetic resonance emerges as a valuable tool for identifying early biomarkers of myocardial dysfunction, offering opportunities for risk stratification and proactive management in cardio-oncology.