Survival rates of childhood cancer have improved, but there is a growing population of childhood cancer survivors with significant heart disease. Anthracycline has a particularly high risk. Unfortunately, anthracycline is partly responsible for improved cancer survival, and thus remains a treatment in over 50% of childhood cancer patients. Oncologists are aware of this risk, and try to identify when the heart is affected. The usual method is by echocardiography. However, echocardiography has limitations that make it ill-equipped to consistently identify patients. One limitation is the detection of a problem is often too late to allow changes. Cardiac MRI is the best test when evaluating hear...

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Survival rates of childhood cancer have improved, but there is a growing population of childhood cancer survivors with significant heart disease. Anthracycline has a particularly high risk. Unfortunately, anthracycline is partly responsible for improved cancer survival, and thus remains a treatment in over 50% of childhood cancer patients. Oncologists are aware of this risk, and try to identify when the heart is affected. The usual method is by echocardiography. However, echocardiography has limitations that make it ill-equipped to consistently identify patients. One limitation is the detection of a problem is often too late to allow changes. Cardiac MRI is the best test when evaluating heart size and function, but is not routinely used in childhood cancer patients. Cardiac MRI has advanced in the last 10 years to show changes with the heart muscle itself, like swelling and fibrosis, which can occur with anthracycline. Cardiac MRI has made great impact in diseases like myocarditis, which is similar, thus it is feasible that cardiac MRI could also have a positive impact in childhood cancer patients and survivors. Because of this emphasis to identify negative heart affects, echocardiography methods have developed to identify changes before there is a large decrease in function. Blood tests can also be done to detect heart damage, and have shown promise in detecting change. In preliminary studies we showed cardiac MRI can be used to identify early changes to the heart that can predict later dysfunction. We showed this in mice, and a small number of childhood cancer patients. We believe a combination of cardiac MRI, echocardiography, and blood tests can be used to predict patients that will develop heart dysfunction during chemotherapy and in patients that have completed cancer treatment. We will perform these tests in children receiving cancer therapy and childhood cancer survivors to identify markers that predict when a heart will become dysfunctional.

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