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There is growing interest in the cardio-toxic effects of chemotherapy. A key question is when to use imaging. In this video, two leaders in the field of cardio-oncology talk about the role of imaging for these patients.
Following is a transcript of their remarks:
Javid Moslehi, MD, Vanderbilt School of Medicine, Nashville, Tennessee: My name is Dr. Javid Moslehi. I direct the Cardio-Oncology program at Vanderbilt, and I'm here with Dr. Marielle Scherrer-Crosbie who directs the echo lab at the University of Pennsylvania, and we're going to give some overviews of this emerging area of cardio-oncology and some of the exciting sessions that have occurred during the ACC this year. Marielle, what sessions are you excited about in cardio-oncology this year?
Marielle Scherrer-Crosbie, MD, PhD, University of Pennsylvania, Philadelphia: Javid, I think there is a lot of excitement on cardio-oncology. It's a new specialty and I've been in that field for many years, mainly from an imaging perspective when I used to work at MGH. Now at Penn, and so I have just come out of a great session that was organized by cardio-oncology council and the imaging council to show, really, what the newest guidelines and trying to disseminate those recommendations to the clinicians.
There's a lot of unanswered questions in cardio-oncology, and so in that session, we went over several cases of patients and one question that seems to be asked over and over again is really a precise and detailed evaluation from a cardiac imaging perspective needed in all patients or only in high-risk patients, in patients undergoing chemotherapy?
Most of the work, as you know, has been done on anthracycline and trastuzumab, but there's now interest in the cardiotoxicity of newer agents and also new forms of cardiotoxicity. Basically what was debated because there is probably no firm conclusions on many of those topics is the role of echo and the role of imaging strain in those patients who have cardiotoxic drugs. What was debated, too, is the role of newer technologies such as CMR and when should you use CMR in those patients? Should you use it also to determine fibrosis? Then in another very exciting topic that is of direct concern to you which is the immunotherapy and myocarditis, what is the role of CMR? I think that you have a lot to say on this particular topic.
Dr. Javid Moslehi: Yes. Let me ask you a difficult question, because one thing that happens, my oncology colleagues following a patient getting a cardiotoxin such as anthracyclines that we know has cardiac effects. Many oncologists do not even order an echocardiogram following treatment with anthracyclines, and yet, in the cardiology world, we are telling people about various imaging modalities. How do we reach out to the oncologists?
Dr. Marielle Scherrer-Crosbie: That's a great question. Actually, one of the questions of the audience in this was exactly that, that we report strain, for example. The oncologists just ignore it. How do we reach to the oncologists? I think that one of the issues that we have is that one of the big studies, SECURE, that has been started to show if strain is really impactful has not yet been finished, nor published. At this point, the recommendation that was made very clear in that session is that based on imaging you cannot continue or discontinue the treatment without talking with the oncologists.