Evidence map›Paper›PMID 34536111›Full record

ArticleEuropean radiology2022

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.

Enver Tahir, Manuella Azar, Sahar Shihada, Katharina Seiffert, Yvonne Goy, Antonia Beitzen-Heineke, Isabel Molwitz, Kai Muellerleile, Christian Stehning, Gerhard Schön and 4 more

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in European radiology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 29 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
29citing papers in PubMed, 4 pooled it
7.1field-weighted citation impact, top 2% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

29 citing papers in PubMed, 4 syntheses or guidelines pooled it, 63 citations in OpenAlex.

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  8. Respiratory navigator-guided multi-slice free-breathing cardiac TPhysics and imaging in radiation oncology · 2025
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 2 institutions in 1 country.

Enver TahirDepartment of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. e.tahir@uke.de.ORCID http://orcid.org/0000-0002-6999-2787
Manuella AzarDepartment of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Sahar ShihadaDepartment of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Katharina SeiffertDepartment of Gynecology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Yvonne GoyDepartment of Radiotherapy and Radio-Oncology, University Hospital Hamburg Eppendorf, Hamburg, Germany.
Antonia Beitzen-HeinekeDepartment of Oncology, Hematology and Bone Marrow Transplantation With the Section Pneumology, University Hospital Hamburg Eppendorf, Hamburg, Germany.
Isabel MolwitzDepartment of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Kai MuellerleileDepartment of General and Interventional Cardiology, University Heart Center, Hamburg, Germany.
Christian StehningPhilips Clinical Science, Hamburg, Germany.
Gerhard SchönDepartment of Medical Biometry and Epidemiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Gerhard AdamDepartment of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Cordula PetersenDepartment of Radiotherapy and Radio-Oncology, University Hospital Hamburg Eppendorf, Hamburg, Germany.
Volkmar MüllerDepartment of Gynecology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Gunnar K LundDepartment of Diagnostic and Interventional Radiology and Nuclear Medicine, University Hospital Hamburg Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
Universität Hamburg · DEPhilips (Germany) · DE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesCancer therapy-related cardiac dysfunction (CTRCD) is a relevant clinical problem and needs early prediction. 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 CTRCD.

methodsSixty-six consecutive women (53 ± 13 years) including n = 39 with epirubicin-based chemotherapy and n = 27 with left-sided radiotherapy were prospectively studied by 3 T CMR including left ventricular (LV) mass and volumes for ejection fraction (LVEF), as well as feature-tracking with global longitudinal strain (GLS) and T1/T2 mapping. CMR was performed at baseline, at therapy completion (follow-up 1, FU1), and after 13 ± 2 months (FU2). CTRCD was defined as LVEF decline of at least 10% to < 55% or a > 15% GLS change at FU2.

resultsT1 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%).

conclusionOnly epirubicin-based chemotherapy, but not left-sided radiotherapy, resulted in increased T1/T2 myocardial relaxation times as a marker of myocardial injury. Combined use of CMR parameters may allow an early prediction of subsequent CTCRD. KEY POINTS: • Myocardial T1 and T2 relaxation times increased at FU1 after epirubicin-based chemotherapy, but not after left-sided radiotherapy. • Cancer therapy-related cardiac dysfunction (CTRCD) occurred in 20% of patients after epirubicin-based chemotherapy and in 4% after left-sided radiotherapy. • Combined use of increased T1 and reduced LVEF had an AUC of 0.810 (0.695-0.896) to predict CTRCD with good sensitivity (78%, 44-95%) and specificity (84%, 72-92%).

Indexed as

Breast NeoplasmsHeart DiseasesVentricular Dysfunction, LeftCardiotoxicityEpirubicinFemaleHumansMagnetic Resonance ImagingMagnetic Resonance Imaging, CinePredictive Value of TestsStroke VolumeVentricular Function, LeftEpirubicinBreast cancerChemotherapyHeartMagnetic resonanceRadiation therapy

Identifiers

PMID34536111
PMCPMC8831341
OpenAlexW3201018304

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.