The coordinator of the Working Group on Cardiology of the Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM), Dr. Francisco Sebastián Palacid, has explained that cardiac toxicity derived from oncological treatment "can appear acutely, in the first year post-treatment, or late, 10 or 20 years later."
This adverse effect of treatments is observed "especially in those who were treated as children," he pointed out, emphasizing that "the follow-up of these patients cannot be limited to the active treatment phase, but must extend far beyond the completion of treatment in higher-risk cases."
In this regard, Sebastián Palacid indicated that one of the main techniques used in this context "is isotopic ventriculography, known as 'MUGA', which is performed before starting chemotherapy to obtain a baseline image of the myocardium and is repeated periodically during treatment in patients receiving drugs with a higher cardiotoxic risk."
He detailed that it is "a complementary technique within a follow-up that today must be multimodal, along with echocardiography, biomarkers, and, when necessary, cardiac resonance," to then emphasize that "its main advantage over other tests is reproducibility." "If heart function decreases between one study and another, we know it is a real change, not a measurement error," he specified.
Risk factors and more vulnerable patients
On the occasion of World Heart Day, which is commemorated on September 29, the specialist highlighted the importance of closely monitoring patients with additional risk factors, such as advanced age, diabetes, or a previous heart condition, as well as those who have received high cumulative doses of cardiotoxic drugs. "In cases of high doses or young patients, follow-up should extend even years after treatment has ended, as cardiotoxicity can appear late," he stressed.
Likewise, it has warned that "women with breast cancer treated with anthracyclines combined with trastuzumab present an especially elevated cardiac risk, just like patients with lymphoma treated with regimens that include anthracyclines and, in many cases, thoracic radiotherapy." "Moreover, the most sensitive group is children and adolescents treated for leukemias or sarcomas, as they receive relatively high doses in a still-developing cardiac muscle, and that damage may not manifest until adulthood," it has added.
"These patients should be followed for decades, not just during treatment," it has insisted, before pointing out that "this type of follow-up allows avoiding unnecessary invasive tests in some patients and, in others, anticipating real damage that otherwise could go unnoticed for years."
Finally, after lamenting that "there is a notable disparity between autonomous communities, and even between hospitals in the same community, in access to nuclear medicine techniques applied in cardiology," it has emphasized that this area "goes far beyond oncological diagnosis." These techniques, it has recalled, "are also used to assess the viability of cardiac muscle or study blood circulation in the heart in patients with ischemic heart disease, with no relation to cancer."