Video by Thomas Marwick, MD, PhD

Specialties: Stress testing, echocardiology and noninvasive testing for coronary disease

Hello, I’m Dr. Thomas Marwick, Section Head of Cardiac Imaging here at the Sydell and Arnold Miller Heart & Vascular Institute at Cleveland Clinic. Today I’m going to talk about the potential cardiac side effects of chemotherapy and the imaging technology available today to help us identify subclinical cardiac dysfunction. Patients who are undergoing radiation and chemotherapy to treat cancer might wonder if their cancer treatment will increase the risk of heart failure or cause the heart to weaken. We know a lot more today about subclinical cardiac dysfunction. We have sophisticated imaging technology to help us identify patients whose hearts may not be happy with cancer medication so we can take measures to prevent heart failure.

As more patients who receive radiation and chemotherapy for cancer survive their diseases, the medical community is seeing increased incidences of radiation-induced heart disease (RIHD), or deterioration of the heart. Of equal concern are cardiac side effects from chemotherapy: an increased risk of heart disease, especially the weakening of the heart muscle—called cardiomyopathy.

In fact, cancer patients today are more likely to die from cardiac side effects than from the cancer drugs. This is why it’s critical for doctors to identify people who are undergoing cancer treatment and who also have a high risk of heart disease or weak hearts that can be further compromised during cancer treatment.

At Cleveland Clinic, experts perform a sophisticated screening process using noninvasive, painless echocardiography to take detailed pictures of the heart. Cleveland Clinic uses a type of imaging called Strain that measures the timing and extent of myocardial deformation. It shows the most subtle changes in the heart so we can catch problems in very early phases. Specifically, Strain shows damaged scar tissue on the heart—a marker we look for when identifying patients who are at risk for heart failure. Strain works the other way, too: It can provide reassurance to patients who do not have scar tissue damage on the heart, and give them peace of mind.

Now, you might be wondering what steps you should take if you have been diagnosed with cancer and will undergo radiation and/or chemotherapy. Just because you are taking cancer medication or going through radiation does not mean you will later suffer from heart disease. Many factors come into play, including family history, the condition of the heart muscle (whether there is existing tissue damage), a weakened heart, or a lifestyle that could contribute to heart problems down the road. What we know about heart failure is that it is a very difficult condition to treat, and it has a high rate of mortality. So, we want to identify people with heart damage that could escalate into heart failure and treat them in a prevention fashion. That Strain echocardiograph screening is a highly effective method of identifying individuals who have heart damage so we can take measures to protect their heart during cancer treatment. (This might include protective heart medications.)

What if you had cancer treatment many years ago—perhaps during childhood? Now, as an adult, you might be anxious about your exercise capacity or worried about cardiac toxicity from the cancer drugs. In this situation, strain imaging can be very reassuring. Studies have shown that people who have “normal” Strain imaging results have healthy hearts years later on subsequent strain imaging. On the other hand, an abnormal strain is a signal that the heart tissue is not 100-percent healthy, prompting regular follow-up with a cardiologist.

What patients need to know if you will undergo radiation and/or chemotherapy is that the first priority is to address the cancer. In conjunction with radiation/chemotherapy, the use of sophisticated noninvasive imaging practiced by experts at Cleveland Clinic can help illustrate how the heart is accepting the cancer treatment so doctors can take steps to protect the heart if necessary.

As a patient, be proactive and ask your doctor about getting an echocardiograph before cancer treatment. Find out the status of your heart health and ask about follow up Strain imaging to identify markers for heart damage years after cancer treatment. The sooner we identify heart deterioration, the better we can protect the heart from failing down the road.