UAB medical Center, Birmingham VA Medical Center Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology Comprehensive Review on Cardio-Oncology: Role of Multi-Modality Imaging Carol Chen-Scarabelli, Chad McRee, Massoud Leesar, Fadi Hage, Tiziano Scarabelli UAB medical Center, Birmingham VA Medical Center Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology BACKGROUND Cancer and cardiovascular (CV) disease are the two leading causes of mortality worldwide. Evolving oncologic therapy, including the use of newer targeted agents, has led to an improvement in survival from childhood and adult-onset cancers. Consequently, there has been a growing realization of cardiotoxic complications related to cancer therapy, with some complications manifesting months to decades after completion of cancer treatment. This manuscript reviews cancer therapeutics-related cardiovascular toxicity and its manifestations, multi-modality imaging techniques for surveillance and detection of this complication, and current state of knowledge in this emerging field. Keywords: cancer, cardiotoxicity, chemotherapy, imaging, radiation Copyright American Society of Nuclear Cardiology

METHODS Study type: (Select all that apply) Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology METHODS Study type: (Select all that apply) review Study subjects: cancer patients treated with chemotherapy and/or radiation therapy Study endpoints: Primary end point(s): cardiotoxicity Secondary end point(s): imaging for detection of cardiotoxicity Study variables: cardiotoxicity, radiation-induced heart disease, imaging Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology RESULTS A B Peak systolic Global Longitudinal Strain (GLS) measured by speckle-tracking echocardiography (STE) along with left ventricular ejection fraction (LVEF) calculation by 3 dimensional echocardiography (3DE) (panel A) and Multi-Gated Acquisition (MUGA) scan (panel B) used for surveillance of left ventricular ejection fraction in cancer patients undergoing chemotherapy. Copyright American Society of Nuclear Cardiology

Journal of Nuclear Cardiology | Official Journal of the American Society of Nuclear Cardiology CONCLUSIONS Numerous diagnostic modalities exist for evaluation of detrimental myocardial changes, such as echocardiography, MUGA, CT, MRI, PET-CT, PET-MRI. While serial clinical assessment is warranted in conjunction with cardiac imaging, it must be reiterated that there is currently a paucity of data with no randomized-controlled trials regarding approaches to detect cardiotoxicity. There exists a need for evolving methods in screening and monitoring, as well as standardized outcome measures, for cardiac dysfunction related to oncologic treatment. Copyright American Society of Nuclear Cardiology