Cancer therapy and the heart: new resource now available to reliably measure strain

Leaders of the Ted Rogers Centre’s Cardiotoxicity Prevention Program have developed a unique new resource that gives health-care professionals anywhere in the world personalized instruction on how to measure cardiac “strain” – and, thus, protect the hearts of people undergoing cancer therapy.

Some cancer survivors can develop heart problems caused by chemotherapy or radiation. Such “cardiotoxicity” ranges from high blood pressure all the way to damaged valves and vessels, and ultimately heart failure. To guard against these outcomes, oncology and cardiology teams can work in tandem to monitor at-risk patients, detect and treat any heart issues early, and follow them for months and years after cancer treatment.

The problem is: the way most heart problems are detected is limited. This spurred our team, led by Dr. Dinesh Thavendiranathan at Peter Munk Cardiac Centre, to create a world-first resource to take a better approach.

Measuring strain: a better standard of care

For years, the standard of care in imaging has been to measure ejection fraction – a metric on the heart’s ability to pump blood out – to determine if cancer therapy is impacting heart function. If physicians see anything, they may pause treatment in a hopeful step to see if the patient’s heart function returns to normal.

“This approach doesn’t work, because it waits until the heart function has already dropped,” Dinesh says. “So these patients still have to stop their treatment and they still may develop heart failure and risk not completing their cancer therapy at all.”

Strain, however, yields an earlier signal that something may be wrong – giving physicians time to act before heart function falls. It is an imaging method, most commonly obtained on echocardiography, that is on the rise with the potential to be a routine resource for doctors to spot warning signs early and identify patients at risk of future disease.

“By measuring strain, we can spot changes in ways we cannot with other imaging methods,” Dinesh says. “For cancer patients, it can show any insult to the heart and forecast possible trouble before ejection fraction drops. As a result, doctors can intervene early.”

In a recent study, our team proved that measuring strain does work to prevent cardiotoxicity in cancer patients. The ultimate goal is to ensure that cancer therapy is uninterrupted, and that long-term heart failure is avoided.

The problem is: there is currently nowhere for doctors to learn how to measure strain in a reliable way.

Introducing: strain resource centre

Despite evidence showing the benefit of strain, physicians and researchers who want to use it have no support in how to properly perform the analysis. Resources to help doctors and allied health-care professionals improve their skills and deploy this emerging technique accurately have not existed – until now.

Our Ted Rogers Cardiotoxicity Prevention Program, based in Toronto, has developed a free new unique resource for those who wish to start performing cardiac strain measurements. Participants anywhere in the world can review our educational materials, analyze real life cases from patients in our cardio-oncology program and receive personalized feedback.

This effort is led by both Dr. Dinesh Thavendiranathan MD, SM, FRCPC, FASE and lead research sonographer for the cardiotoxicity program, Ms. Babitha Thampinathan RDCS, MHSc, FASE.

Here’s how it works: 

  1. Download a set of specific images (CURRENTLY AVAILABLE) or access the images online (COMING SOON).
  2. Analyze the 10 cases using your preferred software (CURRENTLY AVAILABLE – GE ONLY).
  3. Upload your strain measurements back to the website.
  4. Our team assesses your data and delivers personalized feedback.
  5. After the feedback, test your skills on 20 more cases where answers have been confirmed with MRI and careful clinical follow-up.

“Anyone can now launch their own cardio-oncology program to accurately measure strain,” Dinesh says. “More and more physicians are understanding what strain means, and by leveraging the strength our program has in this area, we are aiming to build awareness and education around its use.”

Uncover the possibilities of using strain imaging here.