Anthracycline cardiotoxicity: current methods of diagnosis and possible role of ¹⁸F-FDG PET/CT as a new biomarker

Abstract

Despite advances in chemotherapy, the drugs used in cancer treatment remain rather harmful to the cardiovascular system, causing structural and functional cardiotoxic changes. Positron-emission tomography associated with computed tomography (PET/CT) has emerged like a promising technique in the early diagnosis of these adverse drug effects as the myocardial tissue uptake of fluorodeoxyglucose labeled with fluorine-18 ( ¹⁸F-FDG), a glucose analog, is increased after their use. Among these drugs, anthracyclines are the most frequently associated with cardiotoxicity because they promote heart damage through DNA breaks, and induction of an oxidative, proinflammatory, and toxic environment. This review aimed to present the scientific evidence available so far regarding the use of ¹⁸F-FDG PET/CT as an early biomarker of anthracycline-related cardiotoxicity. Thus, it discusses the physiological basis for its uptake, hypotheses to justify its increase in the myocardium affected by anthracyclines, importance of ¹⁸F-FDG PET/CT findings for cardio-oncology, and primary challenges of incorporating this technique in standard clinical oncology practice.

Highlights

∙ CTX related to chemotherapy is an important cause of heart failure in surviving cancer patients;

∙ Cardiomyocytes may increase their glycolytic metabolism under significant stress. This phenomenon has been observed in both experimental and clinical studies;

∙ PET/CT is a powerful noninvasive diagnostic technique that provides both anatomical and metabolic information;

∙  ¹⁸F-FDG is a glucose analog that is the most commonly used radiopharmaceutical in oncological PET/CT exams;

∙ The degree of myocardial ¹⁸F-FDG uptake may be a promising marker of the cardiomyocyte changes that precede cardiac dysfunction in the CTX cascade.