From the Guidelines
Echocardiography is the preferred first-line test for cardiac evaluation before chemotherapy due to its wider availability, absence of radiation exposure, and ability to assess multiple cardiac parameters beyond ejection fraction. When considering the choice between echocardiography (echo) and gated heart pool scan (MUGA) for cardiac evaluation before chemotherapy, several factors come into play, including the specific chemotherapy regimen, baseline cardiac risk factors, local expertise, and availability.
- Echocardiography offers advantages such as wider availability and absence of radiation exposure, making it a safer option for patients who require repeated monitoring.
- It also provides additional information on cardiac structure and function, including valvular function and diastolic function, which can be crucial in assessing cardiotoxicity.
- MUGA scans, on the other hand, provide more reproducible LVEF measurements with less inter-observer variability, which can be valuable for serial monitoring during cardiotoxic chemotherapy.
- However, the use of MUGA scans is limited by radiation exposure, which can be a significant concern for patients who require frequent monitoring. According to the most recent and highest quality study 1, echocardiography is the first-choice method for evaluating patients before, during, and after chemotherapy, and Left Ventricular Ejection Fraction (LVEF) is the primary technique. The study also recommends the use of Global Longitudinal Strain (GLS) by speckle tracking echocardiography for a sensitive diagnosis of chemotherapy-induced cardiac damage. In cases where the quality of echocardiogram is suboptimal, cardiac magnetic resonance is recommended for LVEF quantification. Overall, the choice between echo and MUGA scans depends on individual patient factors and the specific chemotherapy regimen, but echocardiography is generally the preferred first-line test due to its safety, availability, and ability to provide comprehensive cardiac assessment.
From the FDA Drug Label
The preferred method for assessment of cardiac function is evaluation of LVEF measured by multi-gated radionuclide angiography (MUGA) or echocardiography (ECHO)
Both MUGA and ECHO are recommended for assessing cardiac function before chemotherapy with doxorubicin. The choice between the two methods is not specified, and both are considered acceptable for monitoring cardiac function in patients receiving doxorubicin 2.
From the Research
Comparison of Echo and Gated Heart Pool Scan
- Echo and gated heart pool scan are two diagnostic tools used to assess cardiac function before chemotherapy.
- The choice between these two tests depends on various factors, including the patient's overall health, the type of chemotherapy being used, and the specific concerns of the healthcare provider.
Predictive Value of Echocardiography
- A study published in the European heart journal. Cardiovascular Imaging 3 found that baseline echocardiographic measures of left ventricular size and function can predict the development of symptomatic heart failure or cardiac death in patients treated with anthracyclines.
- The study suggests that parameters such as left ventricular end-diastolic volume (LVEDV) and global longitudinal strain (GLS) can help identify patients who are at higher risk of cardiotoxicity.
Chemotherapy-Induced Cardiotoxicity
- Chemotherapy-induced cardiotoxicity is a major cause of morbidity and mortality in cancer survivors, and can manifest as arrhythmia, hypertension, myocardial ischemia, thromboembolism, heart failure, systolic dysfunction, or other adverse events 4.
- Risk factors for chemotherapy-related cardiac toxicity include age, preexisting left ventricular dysfunction, hypertension, diabetes, and coronary artery disease 5.
Prevention and Treatment of Cardiotoxicity
- Strategies for prevention and treatment of chemotherapy-related cardiotoxicity include the use of cardioprotectant agents, optimization of modifiable risk factors, and close monitoring of cardiac function 6, 7.
- Early detection and management of cardiotoxicity are crucial to preventing long-term cardiac damage and improving outcomes for cancer patients.