Multimodality imaging is more important than ever to the field of cardio-oncology
As cancer therapies become increasingly targeted and complex, the need for sophisticated cardiovascular monitoring has grown as well.
“Multimodality imaging in cardio-oncology is something many of us in the field are truly excited about. Advanced imaging modalities are dramatically improving our ability to catch, diagnose, manage and even prevent cardiovascular disease amongst cancer patients and survivors," explained Daniel Addison, MD, director of translational research in the cardiology division and associate director for survivorship and outcomes eesearch in the Harold C. Simmons Comprehensive Cancer Center at UT Southwestern Medical Center. He is also the hospital's Audre and Bernard Rapport Endowed Chair in Cardiovascular Research. Until recently, Addison was director of the cardio-oncology program at The Ohio State University. He spoke to Cardiovascular Business at American Heart Association Scientific Sessions 2024 meeting.
Addison said the use of multimodality imaging is transforming how clinicians manage cardiovascular risk in cancer patients and survivors. Imaging now underpins nearly every stage of cardio-oncology care—from baseline assessment to long-term survivorship monitoring. Addison sees a future where imaging plays an even more seamless role in cancer care and clinical research.
"As the technologies continue to evolve, we will figure out better ways to more efficiently apply some of these emerging techniques in the space of cancer care," Addison said. "My sincere hope is that more advanced imaging tools will more seamlessly be used in some of our clinical trials going forward, as well as some of our research studies and, importantly, will help us in terms of really improving outcomes,"
Cardio-oncology is moving beyond echocardiography
While echocardiography remains the cornerstone of cardio-oncology imaging, particularly in using global longitudinal strain to monitor cardiac damage caused my cancer treatments, Addison said the field has expanded well beyond ultrasound.
“We’re increasingly using cardiac MRI, cardiac CT, cardiac PET, as well as other forms of nuclear and other kinds of emerging imaging," Addison explained. "We have a wealth of new imaging techniques that are still emerging in terms of how we will actually apply these in patients to actually help improve outcomes."
Integrating imaging with cancer care
Coordination with oncology teams is critical, Addison emphasized. This includes trying to reduce the need for repeat imaging and make it easier for patients whenever possible.
"We try not to be a burden to the patient, but rather an adjunct. So even the timing of the scans should really be done, if possible, in conjunction with other cancer-related imaging the patient may need or have. There are many times when the patient may need standalone imaging just because we really can't wait when we have to do something to actually help improve outcomes for our patients," Addison explained.
Monitoring the heart beyond cancer treatment
Cardio-oncology has also evolved in how it tracks patients over time.
"Increasingly, the longitude of how we actually track these patients has changed. But importantly, we know that both during treatment and then in the years following treatment, it is important to keep some monitoring on how the patient is actually doing or performing," Addison said.
Traditionally, cardio-oncology has focused on chemotherapy drugs and radiation therapies that are known to have related cardiac toxicity. But with the rise of immune checkpoint inhibitors, targeted therapies and biologics, the field has broadened significantly.
"The field of cancer medicine has moved well beyond the anthracycline, trastuzumab and radiation-focused therapies alone. The field of cardio-oncology has also evolved in many ways," Addison explained.
One way the specialty has evolved, he noted, is that more time is being spent tracking cancer treatments over time to see if there are any cardiac impacts. He said there are so many new cancer drugs that it is not fully known yet what the long-term side effects might be of some of them, underscoring the importance of cardio-oncology.
“There have been nearly 200 FDA approvals for new therapies since 2000,” Addison said. “Even if a small percentage impact the heart, that still represents a significant number of patients.”
Cardio-oncology is about managing, not stopping, cancer therapy
Addison also addressed a common misconception—that cardio-oncology is primarily about halting cancer treatment when cardiac side effects arise.
"We don't really think first about how can we prevent or stop the patient from getting their therapy, but really how can we help them have the best outcome, which often involves them getting some level of significant anti-cancer therapy," he said.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]