The status of cardio-oncology in Australia and the application of advanced cardiac imaging

Abstract

Cardio-oncology is a new speciality that has developed in the last couple of decades. It is dedicated to the prevention, identification, and treatment of cardiovascular complications in cancer patients as well as in long-term survivors. Its importance has increased due to significant advances in cancer therapies leading to an increase in potential cardiac complications as well as cardiovascular death becoming a leading cause of death in many cancer types due to improved survival. Cardio-oncology as a speciality in Australia has been limited to date. It is unclear how many cardio-oncology services exist in Australia. A key component of a cardio-oncology service is cardiac imaging. Advanced imaging techniques have improved risk stratification in a variety of cardiovascular conditions. It has yet to be extensively explored in a cardio-oncology setting. We hypothesise there is a lack of cardio-oncology provisions in Australia and the application of advanced cardiac imaging techniques may improve risk stratification of cancer patients at risk of cardiac complications from their cancer therapy.

Conclusion: Our national survey provides important evidence of the desire and need for further cardio-oncology services and education. Though the investigations into left atrial and right ventricular strain did not demonstrate utility in cardiotoxicity risk prediction, these studies add to the knowledge gaps. The significant changes in cardiac magnetic resonance relaxometry in the short term after anthracycline therapy were below the minimal detectable difference meaning its clinical applicability is limited soon after anthracycline therapy. We identified coronary flow velocity reserve as a potential novel cardiac imaging biomarker in cardio-oncology however further studies are required. This thesis has provided insights into the status of cardio-oncology in Australia and the role of certain advanced cardiac imaging biomarkers.