Cardiac Energetics Before, During, And After Anthracycline-Based Chemotherapy In Breast Cancer Patients Using P-31 Magnetic Resonance Spectroscopy: A Pilot Study

Purpose: To explore the utility of phosphorus magnetic resonance spectroscopy (P-31 MRS) in identifying anthracycline-induced cardiac toxicity in patients with breast cancer.Methods: Twenty patients with newly diagnosed breast cancer receiving anthracycline-based chemotherapy had cardiac magnetic resonance assessment of left ventricular ejection fraction (LVEF) and P-31 MRS to determine myocardial Phosphocreatine/Adenosine Triphosphate Ratio (PCr/ATP) at three time points: pre-, mid-, and end-chemotherapy. Plasma high sensitivity cardiac troponin-I (cTn-I) tests and electrocardiograms were also performed at these same time points.Results: Phosphocreatine/Adenosine Triphosphate did not change significantly between pre- and mid-chemo (2.16 +/- 0.46 vs. 2.00 +/- 0.56, p = 0.80) and pre- and end-chemo (2.16 +/- 0.46 vs. 2.17 +/- 0.86, p = 0.99). Mean LVEF reduced significantly by 5.1% between pre- and end-chemo (61.4 +/- 4.4 vs. 56.3 +/- 8.1 %, p = 0.02). Change in PCr/ATP ratios from pre- to end-chemo correlated inversely with changes in LVEF over the same period (r = -0.65, p = 0.006). Plasma cTn-I increased progressively during chemotherapy from pre- to mid-chemo (1.35 +/- 0.81 to 4.40 +/- 2.64 ng/L; p = 0.01) and from mid- to end-chemo (4.40 +/- 2.64 to 18.33 +/- 13.23 ng/L; p = 0.001).Conclusions: In this small cohort pilot study, we did not observe a clear change in mean PCr/ATP values during chemotherapy despite evidence of increased plasma cardiac biomarkers and reduced LVEF. Future similar studies should be adequately powered to take account of patient drop-out and variable changes in PCr/ATP and could include T1 and T2 mapping.