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Appropriateness Criteria

Reference Study Type Patients/Events Study Objective(Purpose of Study) Study Results Study Quality
1. Zamorano JL, Gottfridsson C, Asteggiano R, et al. The cancer patient and cardiology. Eur J Heart Fail 2020;22:2290-309. Review/Other-Tx N/A This paper aims to provide an overview of the main adverse events, risk assessment and risk mitigation strategies, early diagnosis, medical and complementary strategies for prevention and management, and long-term follow-up strategies for patients at risk of cancer therapy-related cardiotoxicities. No results stated in the abstract. 4
2. Lyon AR, Dent S, Stanway S, et al. Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: a position statement and new risk assessment tools from the Cardio-Oncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International Cardio-Oncology Society. Eur J Heart Fail 2020;22:1945-60. Review/Other-Tx N/A This position statement from the Heart Failure Association of the European Society of Cardiology Cardio-Oncology Study Group in collaboration with the International Cardio-Oncology Society presents practical, easy-to-use and evidence-based risk stratification tools for oncologists, haemato-oncologists and cardiologists to use in their clinical practice to risk stratify oncology patients prior to receiving cancer therapies known to cause heart failure or other serious cardiovascular toxicities. No results stated in the abstract. 4
3. Lopez-Mattei JC, Yang EH, Ferencik M, Baldassarre LA, Dent S, Budoff MJ. Cardiac Computed Tomography in Cardio-Oncology: JACC: CardioOncology Primer. JACC CardioOncol 2021;3:635-49. Review/Other-Dx N/A This review describes the optimal utilization of cardiac computed tomography (CT) in cancer patients, including risk assessment for atherosclerotic cardiovascular disease (ASCVD) and identification of cancer treatment-related cardiovascular toxicity. No results stated in the abstract. 4
4. Sturgeon KM, Deng L, Bluethmann SM, et al. A population-based study of cardiovascular disease mortality risk in US cancer patients. Eur Heart J 2019;40:3889-97. Observational-Dx 3,234,256 patients This observational study characterized cardiovascular disease (CVD) mortality risk for multiple cancer sites, with respect to the following: (i) continuous calendar year, (ii) age at diagnosis, and (iii) follow-up time after diagnosis. The Surveillance, Epidemiology, and End Results program was used to compare the US general population to 3,234,256 US cancer survivors (1973-2012). Standardized mortality ratios (SMRs) were calculated using coded cause of death from CVDs (heart disease, hypertension, cerebrovascular disease, atherosclerosis, and aortic aneurysm/dissection). Analyses were adjusted by age, race, and sex. Among 28 cancer types, 1,228,328 patients (38.0%) died from cancer and 365,689 patients (11.3%) died from CVDs. Among CVDs, 76.3% of deaths were due to heart disease. In eight cancer sites, CVD mortality risk surpassed index-cancer mortality risk in at least one calendar year. Cardiovascular disease mortality risk was highest in survivors diagnosed at <35 years of age. Further, CVD mortality risk is highest (SMR 3.93, 95% confidence interval 3.89-3.97) within the first year after cancer diagnosis, and CVD mortality risk remains elevated throughout follow-up compared to the general population. 3
5. White RD, Kirsch J, Bolen MA, et al. ACR Appropriateness Criteria® Suspected New-Onset and Known Nonacute Heart Failure. J Am Coll Radiol 2018;15:S418-S31. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for suspected new-onset and known nonacute heart failure. No results stated in abstract. 4
6. Batlle JC, Kirsch J, Bolen MA, et al. ACR Appropriateness Criteria® Chest Pain-Possible Acute Coronary Syndrome. J Am Coll Radiol 2020;17:S55-S69. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for chest pain-possible acute coronary syndrome. No results stated in abstract. 4
7. Beache GM, Mohammed TH, Hurwitz Koweek LM, et al. ACR Appropriateness Criteria® Acute Nonspecific Chest Pain-Low Probability of Coronary Artery Disease. J Am Coll Radiol 2020;17:S346-S54. Review/Other-Tx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for acute nonspecific chest pain-low probability of coronary artery disease. No results stated in abstract. 4
8. American College of Radiology. ACR–NASCI–SIR–SPR Practice Parameter for the Performance and Interpretation of Body Computed Tomography Angiography (CTA). Available at: https://www.acr.org/-/media/ACR/Files/Practice-Parameters/body-cta.pdf. Review/Other-Dx N/A Guidance document to promote the safe and effective use of diagnostic and therapeutic radiology by describing specific training, skills and techniques. No abstract available. 4
9. Lopez-Mattei J, Yang EH, Baldassarre LA, et al. Cardiac computed tomographic imaging in cardio-oncology: An expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT). Endorsed by the International Cardio-Oncology Society (ICOS). J Cardiovasc Comput Tomogr. 17(1):66-83, 2023 Jan-Feb. Review/Other-Dx N/A The Society of Cardiovascular Computed Tomography (SCCT) convened a group of experts to develop an Expert Consensus Statement to summarize the current evidence for cardiac CT (CCT) applications in Cardio-Oncology and provide practical recommendations for clinicians. No results stated in the abstract. 4
10. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019;74:e177-e232. Review/Other-Dx N/A Evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for primary prevention of cardiovascular disease. No abstract available. 4
11. Blaha MJ, Cainzos-Achirica M, Dardari Z, et al. All-cause and cause-specific mortality in individuals with zero and minimal coronary artery calcium: A long-term, competing risk analysis in the Coronary Artery Calcium Consortium. Atherosclerosis 2020;294:72-79. Review/Other-Dx 66,363 patients The long-term associations between zero, minimal coronary artery calcium (CAC) and cause-specific mortality are currently unknown, particularly after accounting for competing risks with other causes of death. Over a mean of 12 years of follow-up, individuals with CAC=0 (45% prevalence, mean age 45 years) had stable low rates of coronary heart disease (CHD) death, cardiovascular disease (CVD) death (ranging 0.32 to 0.43 per 1,000 person-years), and all-cause death (1.38 to 1.62 per 1,000 person-years). Cancer was the predominant cause of death in this group, yet rates were also very low (0.47 to 0.79 per 1,000 person-years). Compared to CAC=0, individuals with CAC 1–10 had an increased multivariable-adjusted risk of CVD death only under age 40. Individuals with CAC>10 had multivariable-adjusted increased risks of CHD death, CVD death and all-cause death at all ages, and a higher proportion of CVD deaths. 4
12. Lamberg M, Rossman A, Bennett A, et al. Next Generation Risk Markers in Preventive Cardio-oncology. [Review]. Curr Atheroscler Rep. 24(6):443-456, 2022 06. Review/Other-Tx N/A To review and consider the utility of breast arterial calcification (BAC), coronary artery calcification (CAC), clonal hematopoiesis of indeterminate potential (CHIP), and cancer and cancer treatment in cardiovascular disease (CVD) risk assessment. There is evidence supporting the use of BAC, CAC, CHIP, and cancer and cancer treatment for improved CV risk stratification in patients with cancer and those who are being screened for cancer. BAC has been shown to predict CAC, coronary atherosclerotic plaque on coronary CTA, coronary artery stenosis on coronary angiography, and CVD events and accordingly enhances CVD risk stratification beyond the atherosclerotic CVD (ASCVD) risk pooled cohort equation. Additionally, CAC visualized on CT utilized for lung cancer screening, radiation planning, and cancer staging is predictive of coronary artery disease (CAD). Furthermore, CHIP can also be utilized in risk stratification, as the presence of CHIP carries a 40% increase in CV risk independent of traditional CV risk factors. Finally, cancer and many oncologic therapies confer a lifelong increased risk of CVD. We propose an emerging set of tools to be incorporated into the routine continuum of CVD risk assessment in individuals who have been treated for cancer or who are being screened for cancer development. In this review, we discuss BAC, CAC, CHIP, and cancer and cancer treatment as emerging risk markers in cardiovascular health assessment. Their effectiveness in predicting and influencing the burden of CVD will be discussed, along with suggestions on their incorporation into preventive cardio-oncology practice. Future research will focus on short- and long-term CVD outcomes in these populations. 4
13. Blaha MJ, Blankstein R, Nasir K. Coronary Artery Calcium Scores of Zero and Establishing the Concept of Negative Risk Factors. J Am Coll Cardiol 2019;74:12-14. Review/Other-Tx N/A To provide an editorial comment on the coronary artery calcium scores of zero and establishing the concept of negative risk factors. No abstract available. 4
14. Takx RAP, Vliegenthart R, Schoepf UJ, et al. Coronary artery calcium in breast cancer survivors after radiation therapy. Int J Cardiovasc Imaging. 33(9):1425-1431, 2017 Sep. Observational-Dx 333 patients The purpose of the current study is to investigate whether breast cancer survivors after radiation therapy have a higher burden of coronary artery calcium as a potential surrogate of radiation-induced accelerated coronary artery disease. 333 patients were included. 54 patients underwent chest CT = 6 months after the start of radiation therapy (radiation therapy group), while 279 patients had a CT scan either prior to or without undergoing radiation therapy (RT). Coronary artery calcium was quantified from CT by applying a threshold-based automated algorithm. Mean age at diagnosis was similar (p = 0.771) between RT (57.4 ± 13.1 years) and NoRT (58.0 ± 11.9 years). Median time between radiation therapy and CT was 2 years. The groups showed no significant differences in race, smoking history, cancer laterality, or cancer stage. 39 (72.2%) of RT patients had a coronary artery calcium score of 0, compared to 201 (72.0%) in patients without radiation therapy. Median coronary artery calcium burden for both groups was not significantly different (p = 0.982), nor when comparing patients who underwent left- versus right-sided radiation therapy (p = 0.453). When adjusting for the time between diagnosis and CT, radiation therapy patients had a significantly lower risk of a positive coronary artery calcium score. In conclusion, breast cancer survivors after radiation therapy are not more likely to show coronary artery calcium on follow-up CT imaging. Our results thus do not support radiation-induced accelerated coronary artery disease as an explanation for higher rates of heart disease in this group. 2
15. American College of Cardiology Foundation Task Force on Expert Consensus Documents, Hundley WG, Bluemke DA, et al. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. [Review] [426 refs]. J Am Coll Cardiol. 55(23):2614-62, 2010 Jun 08. Review/Other-Dx N/A To: 1) introduce the basic instrumentation, physics, scan techniques, safety parameters, and contraindications associated with CMR acquisitions; 2)  review the use of CMR for assessing patients with cardiovascular disease processes; and 3) unique capabilities of image data generated with CMR are provided relative to other imaging techniques. No abstract available. 4
16. Armenian SH, Lacchetti C, Barac A, et al. Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. 35(8):893-911, 2017 Mar 10. Review/Other-Dx 104 studies The purpose of this effort was to develop recommendations for prevention and monitoring of cardiac dysfunction in survivors of adult-onset cancers. A total of 104 studies met eligibility criteria and compose the evidentiary basis for the recommendations. The strength of the recommendations in these guidelines is based on the quality, amount, and consistency of the evidence and the balance between benefits and harms. 4
17. Nehmeh SA, Fox JJ, Schwartz J, et al. A pilot study of 13N-ammonia cardiac PET imaging to assess subacute cardiotoxicity following adjuvant intensity-modulated radiotherapy for locally advanced breast cancer. Clin Imaging. 68:283-290, 2020 Dec. Observational-Dx 8 patients The objectives of this study are to: (1) Assess the feasibility of 13 N-ammonia cardiac PET (13 N-ammonia-PET) imaging in radiotherapy (RT) treatment position in locally-advanced breast cancer (LABC) patients. (2) Correlate pre-/post-RT changes in myocardial flow reserve (MFR) with the corresponding radiation heart dose. Eight (of 10) patients successfully completed the study. The average rest (stress) global MBF (ml.g-1.min-1) for baseline (follow-up) were 0.83 ± 0.25 (2.4 ± 0.79) and 0.92 ± 0.30 (2.76 ± 0.71), respectively. Differences in MBF, heart rate, blood pressure, and rate-pressure product (RPP) between baseline and follow-up were insignificant (P > 0.1).Strong (R = 0.79; P < 0.01) and moderate (R = 0.53; P = 0.37) correlation existed between MBF Rest and MBF Stress, and RPP respectively. Four patients showed a reduction in MFR of up to ~41% in follow-up studies, increasing to ~52% in myocardial segments close to high-radiation isodose lines in 5/8 patients. Agatston Ca + 2 scoring were zero in both baseline and follow-up in six patients; two patients exhibited mild increase in Ca + 2 on follow-ups (range:10-20).Rest and stress LVEF's were normal (>50) for all patients in both studies. 3
18. Rasmussen T, Kjaer A, Lassen ML, et al. No changes in myocardial perfusion following radiation therapy of left-sided breast cancer: A positron emission tomography study. J Nucl Cardiol. 28(5):1923-1932, 2021 10. Observational-Dx 20 patients The aim of this study was, in a cohort of asymptomatic post-irradiation breast cancer patients, to investigate changes in myocardial blood flow (MBF) and presence of perfusion defects in myocardial perfusion positron-emission-tomography (PET) in the irradiated myocardium. Twenty patients treated with RT for left-sided breast cancer underwent 13N-ammonia myocardial perfusion PET 7(± 2) years after breath adapted RT to a total dose of 48 Gy given in 24 fractions. No differences in rest or stress MBF were noted between the irradiated and non-irradiated myocardium (1.29 (± 0.29) vs 1.33 (± 0.29) mL/g/min, ns; 2.74 (± 0.59) vs 2.78 (± 0.66) mL/g/min, ns, respectively). One patient demonstrated a myocardial perfusion defect localized in the irradiated anterior wall myocardium. 3
19. Divakaran S, Caron JP, Zhou W, et al. Coronary vasomotor dysfunction portends worse outcomes in patients with breast cancer. J Nucl Cardiol. 29(6):3072-3081, 2022 12. Observational-Dx 87 patients To test the utility of myocardial flow reserve (MFR) to predict outcomes in a cohort of patients with breast cancer. The final cohort included 87 patients (median age 69.0 years, 98.9% female, mean MFR 2.05). Over a median follow-up of 7.6 years after PET, the lowest MFR tertile was associated with higher cumulative incidence of MACE (adjusted subdistribution hazard ratio 4.91; 95% CI 1.68-14.38; p = 0.004) when compared with the highest MFR tertile. 3
20. Schwartz RG, McKenzie WB, Alexander J, et al. Congestive heart failure and left ventricular dysfunction complicating doxorubicin therapy. Seven-year experience using serial radionuclide angiocardiography. Am J Med 1987;82:1109-18. Observational-Tx 282 patients To impact on the development of clinical congestive heart failure as a complication of doxorubicin therapy, left ventricular ejection fraction was monitored with serial resting radionuclide angiocardiography in 1,487 patients with cancer over a seven-year period in both university and community hospital environments. A high-risk subset of 282 patients was selected for retrospective analysis of their clinical outcome. High-risk patients were identified by one or two of the following three criteria: (1) decline of 10 percent or more in absolute left ventricular ejection fraction from a normal baseline to 50 percent or less; (2) high cumulative dose of doxorubicin (more than 450 mg/m2); (3) abnormal baseline left ventricular ejection fraction (less than 50 percent). Clinical congestive heart failure occurred in 46 (16 percent) during the treatment period, and in an additional three patients (1.3 percent) at last follow-up examination 11.8 ± 14.2 months following discontinuation of doxorubicin. Total cumulative dosages of doxorubicin that precipitated congestive heart failure (75 to 1,095 mg/m2) and those that did not (30 to 880 mg/m2) varied widely. Decline of 10 percent or more in absolute left ventricular ejection fraction to a value of 50 percent or less preceded administration of the final dose of doxorubicin that precipitated clinical congestive heart failure in the majority of patients in whom congestive heart failure developed. Clinical congestive heart failure improved in 87 percent given routine therapy with digitalis, diuretics, and/or vasodilators. Criteria for monitoring left ventricular ejection fraction and discontinuing doxorubicin were formulated. The occurrence of clinical congestive heart failure was compared in those patients whose management was concordant with proposed criteria (Group A) and in those whose management was not (Group B). Group A had a lower incidence of congestive heart failure compared with Group B (2.9 percent versus 20.8 percent, p <0.001) and had only mild congestive heart failure that resolved with treatment (n = 2) and no deaths due to congestive heart failure. Multivariate analysis with proportional-hazards regression (Cox's model) demonstrated a fourfold reduction in the incidence of congestive heart failure independent of other clinical predictor variables in those patients whose management was concordant with proposed guideline criteria. The incidence, persistence, late development, predictability, and reversibility of clinical congestive heart failure were comparable in university and community hospital settings. It is concluded that in doxorubicin-treated patients at high risk for congestive heart failure, (1) monitoring resting left ventricular function with radionuclide angiocardiography is associated with a low incidence, benign course, and reversible degree of doxorubicin-induced congestive heart failure; (2) adherence to appropriate guidelines reduces the incidence and severity of clinical congestive heart failure; (3) serial resting radionuclide angiocardiography reliably monitors cardiotoxicity and identifies patients who safely tolerate high cumulative doses of doxorubicin. 2
21. Jones KA, Small AD, Ray S, et al. Radionuclide ventriculography phase analysis for risk stratification of patients undergoing cardiotoxic cancer therapy. J Nucl Cardiol. 29(2):581-589, 2022 04. Observational-Dx 177 patients to determine if phase parameters applied to baseline radionuclide ventriculography (RNVG) phase images can measure sub-clinical contraction abnormalities prior to treatment to predict which patients are at a higher risk of cancer therapy-related cardiac dysfunction (CTRCD). Of the 177 patients, 11 had a decline in left ventricular ejection fraction (LVEF) of over 10% to an LVEF below 50% after treatment had commenced. This patient group had a significantly higher ApEn at baseline to those who maintained a normal LVEF throughout treatment. Of the parameters investigated, ApEn was superior for predicting the risk of CTRCD. Combining ApEn with the baseline LVEF further improved the discrimination between the groups. 3
22. Jeyakumar A, DiPenta J, Snow S, et al. Routine cardiac evaluation in patients with early-stage breast cancer before adjuvant chemotherapy. Clin Breast Cancer. 12(1):4-9, 2012 Feb. Observational-Dx 593 patients This population-based study of women diagnosed with early-stage breast cancer aimed to (i) determine the current utilization pattern of multigated acquisition (MUGA) scans before adjuvant chemotherapy (AdjC) treatment, and (ii) examine the impact of MUGA scan results on AdjC decision making. The study included 593 women, of whom 238 (40%) received AdjC (94% anthracycline vs. 6% nonanthracycline) and 198 (33%) underwent baseline MUGA scans. Of those received AdjC, 80% underwent MUGA scans. MUGA scan utilization was associated with AdjC treatment (yes vs. no; P < .0001), Her-2/neu status (positive vs. negative vs. not tested; P < .0001), and AdjC regimen (anthracycline vs. nonanthracycline; P < .0001). Abnormal MUGA results were observed in 5 (2.5%) of 198; all were smokers, and 4 were >65 years of age. In the 1 patient <50 years old, subsequent echocardiograms indicated normal cardiac function. 3
23. Huang H, Nijjar PS, Misialek JR, et al. Accuracy of left ventricular ejection fraction by contemporary multiple gated acquisition scanning in patients with cancer: comparison with cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 19(1):34, 2017 Mar 24. Observational-Dx 75 patients To compare the accuracy of left ventricular ejection fractions (LVEF) obtained by contemporary clinical multiple gated acquisition scans (MUGA) with reference LVEFs from cardiovascular magnetic resonance (CMR) in consecutive patients with cancer. Compared to CMR reference LVEFs, MUGA clinical LVEFs were only lower by a mean of 1.5% (48.5% vs. 50.0%, p = 0.17). However, the limits of agreement between MUGA clinical and CMR reference LVEFs were wide at -19.4 to 16.5%. At LVEF thresholds of 50 and 55%, there was misclassification of 35 and 20% of cancer patients, respectively. 3
24. Zhang P, Hu X, Yue J, et al. Early detection of radiation-induced heart disease using (99m)Tc-MIBI SPECT gated myocardial perfusion imaging in patients with oesophageal cancer during radiotherapy. Radiother Oncol. 115(2):171-8, 2015 May. Observational-Dx 18 patients To investigate the value of (99m)Tc-methoxyisobutylisonitrile (MIBI) single photon emission computed tomography (SPECT) gated myocardial perfusion imaging (GMPI) in the detection of radiation-induced heart disease (RIHD) as early as during radiotherapy (RT) for oesophageal cancer (EC). The second aim was to analyse the correlation between cardiac toxicity and the dose-volume factors. Eighteen patients with locally advanced EC were enrolled in the study. Compared with the baseline, the imaging during RT showed not only significant decreases in the wall motion (WM) (1/20 segments), wall thickening (WT) (2/20 segments), end-diastolic perfusion (EDP) (5/20 segments) and end-systolic perfusion (ESP) (8/20 segments) (p<0.05) but also a significant increase in the heart rate (74.63±7.79 vs 81.49±9.90, p=0.036). New myocardial perfusion defects were observed in 8 of the 18 patients. The V37-V40 was significantly higher (p<0.05) in the patients with the new perfusion defects during RT than in the patients who did not exhibit these defects. 2
25. Habash-Bseiso DE, Rokey R, Berger CJ, Weier AW, Chyou PH. Accuracy of noninvasive ejection fraction measurement in a large community-based clinic. Clin Med Res 2005;3:75-82. Observational-Dx 534 patients The purpose of this study was to retrospectively review clinical medical records to compare readings determined by echocardiography and single photon emission computed tomography (SPECT) to those determined by angiography in the setting of a large clinical practice where multiple persons are involved in the acquisition. Five hundred thirty-four patients underwent 542 angiographic studies: SPECT in all 534 patients, combined SPECT and echocardiographic studies in 201 patients, and combined angiographic and echocardiographic studies in 202 patients. Correlation of angiographic LVEFs with both echocardiographic and SPECT LVEFs was significant (r = 0.70 and r = 0.69, respectively; p<0.0001). Echocardiographic LVEFs were lower than those determined by angiography (49% ± 1.0% versus 54% ± 1.0%;p<0.0001). SPECT LVEFs were also lower than angiographic LVEFs (49% ± 0.6% versus 57% ± 0.6%; p<0.0001). For 201 patients who underwent both SPECT and echocardiography, SPECT LVEFs were lower (47% ± 1.0% for SPECT versus 49% ± 1.0% for echocardiography; p<0.05). Bland-Altman analysis revealed widely varying differences between techniques with broad confidence intervals. Nonetheless, sensitivity and specificity for determining LVEFs of <40% for SPECT and echocardiography were 90% and 86%, and 75% and 89%, respectively. LVEF of =35% was correctly assessed by both SPECT and echocardiography. Sensitivity and specificity for SPECT were 82% and 89%, and 81% and 88% for echocardiography. 3
26. Ali MT, Yucel E, Bouras S, et al. Myocardial Strain Is Associated with Adverse Clinical Cardiac Events in Patients Treated with Anthracyclines. J Am Soc Echocardiogr. 29(6):522-527.e3, 2016 06. Observational-Tx 476 patients The purpose of the present study was to evaluate the value of left ventricle (LV) volumes, left ventricle ejection fraction (LVEF), and LV peak global longitudinal strain (GLS) measured before chemotherapy in identifying the development of symptomatic heart failure and cardiac death in patients with hematologic malignancies treated with anthracyclines. Over a median follow-up period of 1,593 days (range, 13-2,891 days) after the start of chemotherapy, 28 of 450 patients (6%) experienced CEs. Prechemotherapy LVEF and GLS were lower in patients with CEs compared with those without CEs (58 ± 10% vs 62 ± 7% [P = .005] and -15.0 ± 2.8% vs -19.7 ± 2.7% [P < .0001], respectively). Diabetes (hazard ratio [HR], 7.06; P < .0001), hypertension (HR, 2.22; P = .04), LVEF (HR, 0.93; P = .005), and GLS (HR, 1.47; P < .0001) were associated with CEs. After controlling for clinical variables, prechemotherapy GLS remained independently associated with CEs (P < .0001). GLS less than the absolute value of -17.5% was found in 105 patients (23%) and was associated with a sixfold increase in CEs (P < .0001). 2
27. Balanescu DV, Monlezun DJ, Donisan T, et al. A Cancer Paradox: Machine-Learning Backed Propensity-Score Analysis of Coronary Angiography Findings in Cardio-Oncology. J Invasive Cardiol. 31(1):21-26, 2019 01. Observational-Dx 240 patients To assess the cardiovascular risk profile and coronary angiography (CA) findings of cancer patients and compare them to those of patients without cancer. Of the 480 enrolled patients, a total of 240 (50%) had cancer. Fewer cancer vs non-cancer patients had clinically significant lesions on the left anterior descending artery (25.00% vs 39.17%, respectively; P<.01) and left circumflex artery (15.83% vs 30.00%, respectively; P<.001). Left main and right coronary artery disease prevalence was similar. Subjects with cancer were less likely to have multivessel CAD (odds ratio, 0.53; 95% confidence interval, 0.29-0.98; P=.04) and significant left circumflex artery lesions (odds ratio, 0.47; 95% confidence interval, 0.26-0.85; P=.01), independent of known CAD confounders. 3
28. Yang Q, Chen Y, Gao H, et al. Chemotherapy-Related Anatomical Coronary-Artery Disease in Lung Cancer Patients Evaluated by Coronary-Angiography SYNTAX Score. Arq Bras Cardiol. 114(6):1004-1012, 2020 06. Observational-Dx 94 patients The study investigated the association between chemotherapy and atherosclerotic anatomical abnormalities of coronary arteries among lung cancer patients. A total of 94 patients were included in the study. The SXscore was higher in the chemotherapy group than in the non-chemotherapy group (25.25, IQR [4.50-30.00] vs. 16.50, IQR [ 5.00-22.00], p = 0.0195). The SXhigh rate was greater in the chemotherapy group than in the non-chemotherapy group (58.33% vs. 25.86; p = 0.0016). Both univariate (OR:4.013; 95% CI:1.655-9.731) and multivariate (OR:5.868; 95% CI:1.778-19.367) logistic-regression analysis revealed that chemotherapy increased the risk of greater SXhigh rates. Multivariate stepwise logistic-regression analysis showed the risk of more severe anatomical CAD is increased by chemotherapy as a whole by 5.323 times (95% CI: 2.002-14.152), and by platinum-based regimens by 5.850 times (95% CI: 2.027-16.879). 3
29. Rosmini S, Aggarwal A, Chen DH, et al. Cardiac computed tomography in cardio-oncology: an update on recent clinical applications. [Review]. Eur Heart J Cardiovasc Imaging. 22(4):397-405, 2021 03 22. Review/Other-Dx N/A This review aims to provide an update on its current use and accompanying evidence-base for cardiac computed tomography (CT) in the management of cardio-oncology patients. No results stated in the abstract. 4
30. Pepe A, Pizzino F, Gargiulo P, et al. Cardiovascular imaging in the diagnosis and monitoring of cardiotoxicity: cardiovascular magnetic resonance and nuclear cardiology. [Review]. J Cardiovasc Med (Hagerstown). 17 Suppl 1:S45-54, 2016 May. Review/Other-Dx N/A This review of the Working Group on Drug Cardiotoxicity and Cardioprotection of the Italian Society of Cardiology aims to afford an overview of the most important findings from the literature about the role of cardiovascular magnetic resonance (CMR) and nuclear techniques in the management of chemotherapy-treated patients, describe conventional and new parameters for detecting chemotherapy-induced cardiotoxicity (CTX) from both diagnostic and prognostic perspectives and provide integrated insight into the role of CMR and nuclear techniques compared with other imaging tools and versus the positions of the most important international societies. No results stated in the abstract. 4
31. Jafari F, Safaei AM, Hosseini L, et al. The role of cardiac magnetic resonance imaging in the detection and monitoring of cardiotoxicity in patients with breast cancer after treatment: a comprehensive review. [Review]. Heart Fail Rev. 26(3):679-697, 2021 05. Review/Other-Dx N/A To review the performance of various cardiac magnetic resonance (CMR) methods in diagnosing cardiotoxicity in breast cancer (BC), induced by chemotherapy or radiotherapy. No results stated in the abstract. 4
32. Saunderson CED, Plein S, Manisty CH. Role of cardiovascular magnetic resonance imaging in cardio-oncology. [Review]. Eur Heart J Cardiovasc Imaging. 22(4):383-396, 2021 03 22. Review/Other-Dx N/A To discuss the current and potential future applications of cardiovascular magnetic resonance (CMR) in the investigation and management of cancer patients. No results stated in the abstract. 4
33. Higgins AY, Arbune A, Soufer A, et al. Left ventricular myocardial strain and tissue characterization by cardiac magnetic resonance imaging in immune checkpoint inhibitor associated cardiotoxicity. PLoS ONE. 16(2):e0246764, 2021. Observational-Dx 20 patients To systematically and comprehensively analyzed cardiac magnetic resonances (CMRs) of patients referred for evaluation of suspected immune checkpoint inhibitors (ICIs) myocarditis for quantitative strain, late gadolinium enhancement (LGE), and T2-weighted (T2W) abnormalities. Of the 20 patients referred, the median left ventricular ejection fraction (LVEF) was 52.5% ± 19.1 and 50% had a normal LVEF (=53%). FT strain analysis revealed an average abnormal global longitudinal strain (GLS) of -9.8%± 4.2%. In patients with a normal LVEF, the average GLS remained depressed at -12.3%± 2.4%. In all patients, GLS demonstrated a significant negative correlation with LVEF (rs = -0.64, p 0.002). Sixteen patients (80%) had presence of LGE (14 non-ischemic pattern and 2 ischemic). Percent LGE did not correlate with any CMR parameters and notably did not correlate with LVEF (rs = -0.29, p = 0.22) or GLS (rs = 0.10, p = 0.67), highlighting the value of tissue characterization beyond functional assessment. Nine patients (45%) met full Updated Lake Louise Criteria and 85% met at least one criterion, suggestive of myocarditis in the correct clinical context. Thirteen patients (65%) were treated for ICI-associated myocarditis and, of these, 54% (n = 7) had recovery of LVEF to normal. There was no correlation between LVEF (p = 0.47), GLS (0.89), or % LGE (0.15) and recovery of LVEF with treatment. 3
34. Tahir E, Azar M, Shihada S, et al. Myocardial injury detected by T1 and T2 mapping on CMR predicts subsequent cancer therapy-related cardiac dysfunction in patients with breast cancer treated by epirubicin-based chemotherapy or left-sided RT. Eur Radiol. 32(3):1853-1865, 2022 Mar. Observational-Dx 66 patients This study aimed to analyze myocardial injury using serial laboratory and cardiac magnetic resonance imaging (CMR) parameters after epirubicin-based chemotherapy compared with left-sided radiotherapy and to study their value for early prediction of cancer therapy-related cardiac dysfunction (CTRCD). T1 and T2 increased at FU1 after epirubicin-based chemotherapy, but not after left-sided radiotherapy. CTRCD occurred in 20% of patients after epirubicin-based chemotherapy and in 4% after left-sided radiotherapy. T1 at FU1 was the best single parameter to predict CTRCD with an area under the curve (AUC) of 0.712 (CI 0.587-0.816, p = 0.005) with excellent sensitivity (100%, 66-100%), but low specificity (44%, 31-58%). Combined use of increased T1 and LVEF = 60% at FU1 improved AUC to 0.810 (0.695-0.896) resulting in good sensitivity (78%, 44-95%) and specificity (84%, 72-92%). 2
35. Gambril JA, Chum A, Goyal A, et al. Cardiovascular Imaging in Cardio-Oncology: The Role of Echocardiography and Cardiac MRI in Modern Cardio-Oncology. [Review]. Heart Fail Clin. 18(3):455-478, 2022 Jul. Review/Other-Dx N/A To review and discuss current evidence for use of echocardiography and cardiac magnetic resonance (CMR) in cardio-oncology and practical clinical uses for each. No results stated in the abstract. 4
36. Cau R, Solinas C, De Silva P, et al. Role of cardiac MRI in the diagnosis of immune checkpoint inhibitor-associated myocarditis. [Review]. Int J Cancer. 151(11):1860-1873, 2022 Dec 01. Review/Other-Dx N/A This narrative review summarizes the clinical aspects of immune checkpoint inhibitor (ICI)-associated myocarditis, highlighting its radiological aspects and proposing a novel algorithm for the use of cardiac magnetic resonance (CMR). No results stated in the abstract. 4
37. Barthur A, Brezden-Masley C, Connelly KA, et al. Longitudinal assessment of right ventricular structure and function by cardiovascular magnetic resonance in breast cancer patients treated with trastuzumab: a prospective observational study. J Cardiovasc Magn Reson. 19(1):44, 2017 Apr 10. Observational-Dx 41 females To evaluate the temporal changes in right ventricular (RV) structure and function as measured by cardiovascular magnetic resonance (CMR), and their relationship with left ventricular (LV) structure and function in breast cancer patients treated with trastuzumab. Of the 41 women (age 52 ± 11 years), only one patient experienced trastuzumab-induced cardiotoxicity. Compared to baseline, there were small but significant increases in the RV end-diastolic volume at 6 months (p = 0.002) and RV end-systolic volume at 6 and 12 months (p < 0.001 for both), but not at 18 months (p = 0.82 and 0.13 respectively). RV ejection fraction (RVEF), when compared to baseline (58.3%, 95% CI 57.1-59.5%), showed corresponding decreases at 6 months (53.9%, 95% CI 52.5-55.4%, p < 0.001) and 12 months (55%, 95% CI 53.8-56.2%, p < 0.001) that recovered at 18 months (56.6%, 95% CI 55.1-58.0%, p = 0.08). Although the temporal pattern of changes in LVEF and RVEF were similar, there was no significant correlation between RVEF and LVEF at baseline (r = 0.29, p = 0.07) or between their changes at 6 months (r = 0.24, p = 0.17). 2
38. Heggemann F, Grotz H, Welzel G, et al. Cardiac Function After Multimodal Breast Cancer Therapy Assessed With Functional Magnetic Resonance Imaging and Echocardiography Imaging. Int J Radiat Oncol Biol Phys. 93(4):836-44, 2015 Nov 15. Observational-Dx 49 patients Cardiac MRI and conventional and 2-dimensional strain echocardiography (2DSE) were used to evaluate morphologic and functional cardiac changes after radiation therapy with 3DCRT (minimal to moderate cardiac exposure) or intensity modulated radiation therapy (IMRT) (patients with unacceptably high heart doses upon 3DCRT), with or without chemotherapy sequentially before and between 6 and 24 months after therapy. Mean heart dose for IMRT was 12.9 ± 3.9 Gy versus 4.5 ± 2.4 Gy for 3DCRT. Heart volumes receiving >40 Gy were 2.6% (3DCRT) versus 1.3% (IMRT); doses were >50 Gy only with 3DCRT. Temporary ejection fraction (EF) decrease was observed on MRI after 6 months (63%-59%, P=.005) resolving at 24 months. Only 3 patients had pronounced largely transient changes of EF and left ventricular enddiastolic diameter (LVEDD). Mitral (M) and tricuspid (T) annular plane systolic excursion (MAPSE and TAPSE) were reduced over the whole cohort (still within normal range). After 24 months left ventricular remodeling index decreased in patients receiving chemotherapy (0.80 vs 0.70, P=.028). Neither wall motion abnormalities nor late enhancements were found. On echocardiography, in addition to EF findings that were similar to those on MRI, global strain was unchanged over the whole cohort at 24 months after a transient decrease at 6 and 12 months. Longitudinal strain decreased in the whole cohort after 24 months in some segments, whereas it increased in others. 2
39. Lancellotti P, Nkomo VT, Badano LP, et al. Expert consensus for multi-modality imaging evaluation of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging. 14(8):721-40, 2013 Aug. Review/Other-Dx N/A Consensus summary from the European Association of Cardiovascular Imaging and the American Society of Echocardiography that discusses several imaging approaches used to detect, evaluate, and monitor radiation-induced heart disease (RIHD) . No results stated in the abstract. 4
40. Lyon WJ, Baker RA, Andrew MJ, Tirimacco R, White GH, Knight JL. Relationship between elevated preoperative troponin T and adverse outcomes following cardiac surgery. ANZ J Surg 2003;73:40-4. Observational-Dx 696 patients The aim of the present study was to determine if elevated preoperative troponin T (TnT)  is a predictor of more complex recovery outcomes in the cardiac surgical setting. Elevated preoperative TnT levels were detected in 10% (71/696) of patients. Compared to patients with normal TnT levels, elevated preoperative TnT increased the risk of mortality at 30 days (7%vs 1%, P=0.004, odds ratio (OR)=6.7) and 2 years (14%vs 3%, P<0.001, OR=5.0), and resulted in prolonged intensive care unit (ICU) stays (P<0.001) and longer postoperative hospitalization (P<0.001). Elevated preoperative TnT was also associated with an increased need for perioperative and postoperative cardiovascular support, early ischaemic change and postoperative congestive cardiac failure. In multivariate analyses preoperative TnT was a significant independent predictor of 30-day and 2-year mortality, and duration of ICU stay. 3
41. Plana JC, Thavendiranathan P, Bucciarelli-Ducci C, Lancellotti P. Multi-Modality Imaging in the Assessment of Cardiovascular Toxicity in the Cancer Patient. [Review]. JACC Cardiovasc Imaging. 11(8):1173-1186, 2018 08. Review/Other-Dx N/A This report discusses advanced multi-modality imaging and how it can be used to stratify patients’ risk before cancer therapy is started, identify early cardiovascular injury during therapy, predict recovery from injury, and detect cardiovascular injury in long-term cancer survivors No results stated in the abstract. 4
42. Sawaya H, Sebag IA, Plana JC, et al. Assessment of echocardiography and biomarkers for the extended prediction of cardiotoxicity in patients treated with anthracyclines, taxanes, and trastuzumab. Circ Cardiovasc Imaging. 5(5):596-603, 2012 Sep 01. Observational-Dx 81 patients The present study investigates whether early alterations of myocardial strain and blood biomarkers predict incident cardiotoxicity in patients with breast cancer during treatment with anthracyclines, taxanes, and trastuzumab. Eighty-one women with newly diagnosed human epidermal growth factor receptor 2–positive breast cancer, treated with anthracyclines followed by taxanes and trastuzumab were enrolled to be evaluated every 3 months during their cancer therapy (total of 15 months) using echocardiograms and blood samples. Left ventricular ejection fraction, peak systolic longitudinal, radial, and circumferential myocardial strain were calculated. Ultrasensitive troponin I, N-terminal pro–B-type natriuretic peptide, and the interleukin family member (ST2) were also measured. Left ventricular ejection fraction decreased (64 ± 5% to 59 ± 6%; P<0.0001) over 15 months. Twenty-six patients (32%, [22%–43%]) developed cardiotoxicity as defined by the Cardiac Review and Evaluation Committee Reviewing Trastuzumab; of these patients, 5 (6%, [2%–14%]) had symptoms of heart failure. Peak systolic longitudinal myocardial strain and ultrasensitive troponin I measured at the completion of anthracyclines treatment predicted the subsequent development of cardiotoxicity; no significant associations were observed for left ventricular ejection fraction, N-terminal pro–B-type natriuretic peptide, and ST2. Longitudinal strain was <19% in all patients who later developed heart failure. 2
43. Christiansen JR, Massey R, Dalen H, et al. Utility of Global Longitudinal Strain by Echocardiography to Detect Left Ventricular Dysfunction in Long-Term Adult Survivors of Childhood Lymphoma and Acute Lymphoblastic Leukemia. Am J Cardiol. 118(3):446-52, 2016 08 01. Observational-Dx 259 patients (191 in primary study group, 231 in secondary study group) To test the hypothesis that lobal longitudinal strain (GLS) is useful in detecting left ventricular (LV) dysfunction in survivors with apparently normal LV systolic function and second to evaluate the relation between GLS and risk factors in the survivors, including previous cardiotoxic treatment. We compared GLS in the survivors with 180 controls. Mean GLS was -19.0 ± 2.2% in the survivor group and -21.4 ± 2.0% in the controls (p <0.001). Impaired GLS, defined as mean - 1.96 SDs in the control group, occurred in 53 of 191 survivors (28%). We included survivors with impaired LV ejection fraction and/or FS or traditional risk factors (n = 231 in all) in multiple regression analyses to explore associations with previous cancer treatment. Survivors treated with mediastinal radiotherapy had an odds ratio of impaired GLS of 5.2 (95% confidence interval 2.2 to 12) compared with other survivors. Survivors treated with cumulative anthracycline doses >300 mg/m(2) had an odds ratio of 4.8 (95% confidence interval 1.7 to 14) of impaired GLS. In conclusion, this study demonstrates a high proportion of LV dysfunction assessed by GLS in apparently healthy adult survivors of childhood cancer. Impaired GLS was associated with previous exposure to mediastinal radiotherapy and high doses of anthracyclines. The prognostic role of measuring GLS in this specific patient population should be examined in prospective studies. 3
44. Hatazawa K, Tanaka H, Nonaka A, et al. Baseline Global Longitudinal Strain as a Predictor of Left Ventricular Dysfunction and Hospitalization for Heart Failure of Patients With Malignant Lymphoma After Anthracycline Therapy. Circulation Journal. 82(10):2566-2574, 2018 09 25.Circ J. 82(10):2566-2574, 2018 09 25. Observational-Dx 73 patients To investigate the baseline clinical and echocardiographic parameters for predicting left ventricular (LV) dysfunction after anthracycline chemotherapy and heart failure (HF) hospitalization in a single cancer disease. We studied 73 patients with malignant lymphoma and preserved LV ejection fraction (LVEF). Echocardiography was performed before and after anthracycline chemotherapy. Global longitudinal strain (GLS) was determined from 3 standard apical views. LV dysfunction after anthracycline chemotherapy was defined according to the current definition of cancer therapeutics-related cardiac dysfunction. Long-term (50-month) unfavorable outcome was prespecified as hospitalization for HF. A total of 10 patients had LV dysfunction after anthracycline chemotherapy. Multivariate logistic regression analysis showed that baseline GLS was the only independent predictor of this dysfunction. Receiver-operating characteristic curve analysis identified the optimal GLS cutoff for predicting LV dysfunction after anthracycline chemotherapy as =19% (P=0.008). Furthermore, the Kaplan-Meier curve indicated that fewer patients with GLS >19% were hospitalized for HF than among those with GLS =19% (log-rank P=0.02). For sequential logistic models, a model based on baseline clinical variables (?2=2.9) was improved by the addition of baseline LVEF (?2=9.0; P=0.01), and further improved by the addition of baseline GLS (?2=13.1, P=0.04). 2
45. Trivedi SJ, Choudhary P, Lo Q, et al. Persistent reduction in global longitudinal strain in the longer term after radiation therapy in patients with breast cancer. Radiother Oncol. 132:148-154, 2019 03. Observational-Dx 40 patients Our aim was to determine whether the early changes observed in left ventricular (LV) strain measurements following radiation therapy (RT) would persist at 12-month follow-up. An increase in LV end diastolic and end systolic volumes was seen from baseline, consistent with persistent LV remodelling; however, due to the increase in both systolic and diastolic volumes over time, no change in LV ejection fraction (EF) was observed. Global longitudinal strain (GLS) and S0 velocity remained significantly lower at 12 months post-RT. GLS dropped by >10% in 16 patients and by >20% in 4 patients compared to baseline. 2
46. National Academies of Sciences, Engineering, and Medicine; Division of Behavioral and Social Sciences and Education; Committee on National Statistics; Committee on Measuring Sex, Gender Identity, and Sexual Orientation. Measuring Sex, Gender Identity, and Sexual Orientation. In: Becker T, Chin M, Bates N, eds. Measuring Sex, Gender Identity, and Sexual Orientation. Washington (DC): National Academies Press (US) Copyright 2022 by the National Academy of Sciences. All rights reserved.; 2022. Review/Other-Dx N/A Sex and gender are often conflated under the assumptions that they are mutually determined and do not differ from each other; however, the growing visibility of transgender and intersex populations, as well as efforts to improve the measurement of sex and gender across many scientific fields, has demonstrated the need to reconsider how sex, gender, and the relationship between them are conceptualized. No abstract available. 4
47. American College of Radiology. ACR Appropriateness Criteria® Radiation Dose Assessment Introduction. Available at: https://www.acr.org/-/media/ACR/Files/Appropriateness-Criteria/RadiationDoseAssessmentIntro.pdf. Review/Other-Dx N/A To provide evidence-based guidelines on exposure of patients to ionizing radiation. No abstract available. 4
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