Early Detection of Anthracycline-induced Cardiotoxicity by Stress Radionuclide Cineangiography in Conjunction with Fourier Amplitude and Phase Analysis

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Abstract
Thirty-three cases of anthracycline related cardiotoxicity occurred in patients with a previosuly negative cardiovascular history, physical examination, and normal ECG. A total of 95 RNCA [radionuclide cineangiography]studies were performed in this group (73 studies included both rest and exercise RNCA). Twenty-one patients had 2 or more serial studies. Seventeen had a normal, base-line prechemotherapy study and 16 had studies done following the initiation of therapy. Fourier analysis, consisting of amplitude and phase images, were created for each study. In the subset with a baseline study, the rest LVEF [left ventricle ejection fraction] became abnormal first in 2 of 17 patients (12%), the rest or stress LVEF in 10 of 17 (59%), the rest fourier image analysis in 10 of 17 (59%) and the rest or stress Fourier image analysis in 16 of 17 (94%). In the subset without a baseline study, the rest LVEF was abnormal in 10 of 16 (63%), the rest or stress LVEF in 16 of 16, (94%), the rest Fourier image analysis in 16 of 16 (100%), and the rest or stress Fourier image analysis in 16 of 16 (100%). The exercise RNCA is superior to the rest RNCA alone in the early detection of anthracycline related cardiotoxicity; the single most sensitive indicator of cardiotoxicity is Fourier image analysis; and sequential rest and stress RNCA studies with Fourier amplitude and phase analysis is the most sensitive noninvasive method of evaluating patients who receive potentially cardiotoxic agents.

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