Work

Prospective multicenter evaluation of 18F-FDG PET/CT and strain for early cardiotoxicity detection in lymphoma patients

Year: 2025

Type: article

Abstract: Anthracycline-induced cardiotoxicity (CTX) requires close monitoring in lymphoma patients. Increased myocardial uptake of fluorine-18-fluorodeoxyglucose (18F-FDG) via positron emission tomography combined with computed tomography (PET/CT) may reflect early metabolic alterations and serve as a potential marker for CTX. To evaluate changes in cardiac metabolism, myocardial strain, and troponin levels during anthracycline-based chemotherapy. This prospective multicenter study included 55 adult lymphoma patients receiving anthracycline therapy. Echocardiography, high-sensitivity troponin, and cardiac 18F-FDG PET/CT were performed at baseline, mid-therapy, and posttreatment. CTX was defined as a ≥ 15% reduction in global longitudinal strain (GLS) from baseline. The mean age was 42 ± 16.7 years; 60% were female. Subclinical CTX occurred in 34% of patients, with a GLS decline observed after 3 months of follow-up, despite preserved left ventricular ejection fraction (LVEF). CTX was associated with older age, hypertension, diabetes, and dyslipidemia. Troponin levels were elevated in 33% but did not differ between the CTX and non-CTX groups. Myocardial 18F-FDG uptake increased in 49.1% of patients (≥ 30% standardized uptake value increase), without correlation with GLS or LVEF changes. GLS can detect early myocardial changes in lymphoma patients treated with anthracyclines, whereas increased 18F-FDG uptake on PET/CT did not correlate with ventricular dysfunction. The clinical significance of myocardial metabolic upregulation requires further investigation. In lymphoma patients receiving anthracycline-based chemotherapy increases in myocardial 18F-FDG uptake and troponin levels are common, but neither has a consistent association with changes in ventricular function. Subclinical cardiotoxicity, as defined by changes in GLS, occurs more frequently in individuals with traditional cardiovascular risk factors such as older age, hypertension, diabetes, and dyslipidemia. The clinical and prognostic implications of increased FDG uptake and other biomarkers remain unclear and warrant further investigation in larger, more diverse populations and with alternative endpoints. Further prospective studies, including diverse cancer types, high-risk populations, and with longer follow-up periods are needed to determine the prognostic value of myocardial 18F-FDG uptake in predicting long-term cardiotoxicity. The development and validation of targeted radiotracers may increase the sensitivity and specificity of PET/CT for early cardiotoxicity detection and improve risk stratification in cardio-oncology.

Source: Cardio-Oncology

DOI: 10.1186/s40959-025-00416-4