182 Role and clinical utility of cardiac magnetic resonance in the management of female cardio-oncology patients

Background Advances in cancer treatment have revolutionized survival outcomes over the past decades but many anti-cancer treatments have cardiotoxic side effects. Furthermore, many cancer survivors go on to develop cardiovascular disease. Cardiac magnetic resonance imaging (CMR) is a key imaging technique in the assessment and management of cardiovascular disease, but its role in patients with history of cancer has not been fully defined. Female patients are under-represented in cardiovascular clinical trials and may benefit from tailored investigations and treatments. In this study we aimed to evaluate the clinical utility and role of CMR in the management of female patients with history of cancer. Methods Between 2013–2023, 126 female patients (mean age 71 +/- 15 years) undergoing cancer treatment or with history of previous cancer treatment were identified. A standard CMR exam included ventricular volumes, function, stress perfusion and late gadolinium enhancement (LGE) imaging was successfully completed in 120/126 of the patients. Details regarding patient's cancer, treatment and cardiovascular risk factors were obtained from patients' clinical notes. The indication for scan, CMR findings and impact of CMR results on patients' clinical outcomes were recorded. Results The indication for cardiac MRI was related to the cancer diagnosis in 64(53%) of the patients; 48% for the assessment of cardiac function in context of cancer treatment and 5% to look for direct cardiac involvement of cancer (e.g. masses). In 47% of the patients, the clinical indication was unrelated to their previous cancer history. The most common types of cancer were found to be breast (46/126, 37%), haematological (25/126, 20%) and lung (16/126, 13%). Whilst the largest proportion of patients (69%), were treated with surgery followed by chemotherapy (65%) and radiotherapy (22%). The most common cardiovascular comorbidities were hypertension (37%), followed by ischemic heart disease (21%), dyslipidaemia (20%), atrial fibrillation (17%) and diabetes (15%). 18% of cancer patients who underwent CMR had left ventricular (LV) systolic dysfunction. Cancer treatment led to immunotherapy related myocarditis in 5/64 (8%) of the patients on active cancer treatment. 4/64 (5%) of the patients were found to have diffuse LGE in keeping with cardiac amyloid (all in the context of myeloma). The number of patients with a new diagnosis of myocardial infarction (subendocardial LGE) in relation to active cancer treatment was only 4/64 (6%). Only 2 patients were diagnosed with intracardiac masses, where histology showed sarcoma in one case and melanoma in the other. 42/64 of the patients on active cancer treatment had completely normal studies which facilitated ongoing cancer treatment. Overall, CMR helped to identify cardiac dysfunction, such as ischemic insult, myocarditis and ventricular systolic impairment as a consequence of cancer treatment in cancer patients. For instance, in 11/22 (50%) patients who had developed LV systolic dysfunction as a direct result of cancer therapy, early identification of systolic impairment alongside aetiology assessment of LV dysfunction by use of cardiac MRI, allowed intensive cardiovascular treatment leading to normalization of LV systolic function subsequently. All patients with cardiac dysfunction post cancer therapy were managed at specialist cardiology clinic and received remodelling agents such as Angiotensin-converting enzyme (ACE) inhibitors and beta blockers in context of LV systolic dysfunction. Conclusion CMR has an important role in aiding clinical decision-making in female patients with cardiac risk factors and a history of cancer and in assessing cardiac toxicity of cancer treatment. It allows early risk stratification and guides preventive and treatment strategies. Conflict of Interest none