The Utility of Cardiac Reserve for the Early Detection of Cancer Treatment-Related Cardiac Dysfunction: A Comprehensive Overview

Figure 1. Graphical representation of the hypothesized trajectory of cardiac reserve and resting cardiac function following cancer treatment whereby reductions in cardiac reserve often precede measurable reductions in resting function.

Figure 2. Example of stroke volume assessment with Doppler and 2D echocardiography. Using Doppler echocardiography, SV is calculated as the product of the cross-sectional area (CSA) of the LV outflow tract (a) and the velocity time integral (VTI) of flow through that area (b). (c,d) Illustrate endocardial border delineation in a single plane four chamber view with 2DE. SV and EF are calculated with the summation of disks method, using geometrical assumptions.

Figure 3. Deformation imaging with exercise can provide insights into subtle cardiac dysfunction. In this example, resting longitudinal strain assessed by 2D speckle tracking echocardiography is reduced in both patients. However, in the healthy heart strain increases from −14 to −23% but in the heart with abnormal contractility the strain does not augment with exercise. Furthermore, note that in the abnormal heart, the peak strain becomes progressively more delayed.

Figure 4. Example of LV function assessment with equilibrium-gated radionuclide angiocardiography. After drawing a region of interest (ROI) at end-diastole (blue contour) and end-systole (yellow contour), a complete LV volume curve or time-activity curve can be generated. The measured LV counts within these LV ROIs are corrected for background activity (BkCorr), which is measured using a ROI adjacent to the end-systolic border (green contour). LVEF is then calculated using the equation: [(BkCorr end-diastolic counts – BkCorr end-systolic counts)/BkCorr end-diastolic counts] × 100. Phase and amplitude analysis provide quantitative information about regional wall motion.

Figure 5. Example of biventricular volume analysis with exercise CMR. The images presented in this figure are end-diastolic image slices in the short axis that cover the heart from apex (upper left image) to base (lower right image). At all slice levels, LV and RV endocardial borders are delineated in red and pink, respectively. The LV and RV volume within each slice is derived as the area within the red and pink contours, respectively, times slice thickness. For each ventricle, the total end-diastolic volume is calculated as the sum of the volumes of all slices from apex to base. Similarly, LV and RV end-systolic volume is the sum of the slice volumes obtained at end-systole (not shown here).