204 - Identification of Subclinical Myocardial Dysfunction by fastSENC Cardiac Magnetic Resonance Imaging in Cardio-Oncology Patients

Poster Number: 204
Publication Number: 204.203

Olga H. Toro-Salazar, Connecticut Children's Medical Center, Hartford, CT, United States; Tiffany L. Ruiz, Connecticut Children's Medical Center, Hartford, CT, United States; James Whayne, Myocardial Solutions, Morrisville, NC, United States; Farouk N. Osman, MyoCardial Solutions, Cary, NC, United States; Andrea Orsey, Connecticut Children's Medical Center, HARTFORD, CT, United States; Erin Trask, Connecticut Children's, Coventry, CT, United States; Anudeep Dodeja, Connecticut Children's Medical Center, Hartford, CT, United States

Background: Cancer therapy-related cardiac dysfunction (CTRCD) is a major contributing factor to morbidity and mortality in pediatric oncology patients exposed to cardiotoxic drugs.^1,2 Advanced cardiac MRI (CMR) sequences, such as fast-SENC, enable quantification of global longitudinal (GLS) and circumferential (GCS) strain magnitude and parameters of regional systolic and diastolic dyssynchrony: standard deviation of time to peak strain, correlation (consistent timing and shape of longitudinal strain curves), and pre-and post-systolic septal slopes^3,4 adding to our understanding of myocardial mechanical adaptation to cardiac injury.

Objective: The objective of this pilot study is to assess the feasibility of fastSENC to identify subclinical myocardial dysfunction in pediatric cancer patients exposed to cardiotoxic therapy.

Design/Methods: Twelve subjects, (Median/IQ) 18.5, 2 yrs, with cumulative anthracycline doses 317.8, 266.6mg/m², 5/12 (41.7%) female underwent CMR between April-Sept 2022 (Table 1). LV volumes, mass, mass/volume, end systolic fiber stress, ejection fraction, stroke volume index, and RV and LV GCS and GLS and percentage of myocardial segments with strain ≤-17% (MyoHealth) based on fastSENC, were calculated. Patients were risk stratified based on known CV and cancer therapy risk factors and given a composite score to categorize in low, moderate, and high risk. FastSENC variables were compared to echo and CMR derived measures of global and regional myocardial function.

Results: Cardio-oncology patients had reduced function by MyoHealth and MyoStrain parameters of dyssynchrony, compared to normal (n=6) (Figure 1). CMR derived LV and RV EF, SVi, GLS, GCS, and MyoHealth decreased with increasing heart failure stage and correlated with composite risk score of cardiotoxicity (Table 2). Patients in active treatment and moderate to high risk groups had lower MyoHealth and strain parameters of regional systolic and diastolic dyssynchrony (Table 2, Figure 1). Abnormal MyoHealth identified 4 patients with subclinical LV dysfunction compared to LVEF by CMR, 8 patients compared to 2D LVEF, and 5 patients compared to 3D LVEF by echo.

Conclusion(s): MyoHealth as determined by fastSENC, enables improved identification of patients with subclinical LV dysfunction compared with LVEF by CMR and 2D- and 3D-echo. Subclinical abnormalities in LV GLS, LV GCS, RV GCS, and parameters of regional systolic and diastolic dyssynchrony are highly prevalent. Ability to identify subclinical myocardial dysfunction in patients at high risk for cardiotoxicity may allow early therapeutic intervention and improved outcomes.