"Cardio-Oncology" - Cased-Based Webinar (CME)-Video

Video Transcription

Video Summary

This final SCMR case-based webinar focused on the expanding role of cardiac MRI (CMR) in cardio-oncology, with moderators thanking the webinar task force and emphasizing the series’ collaborative success.

Four main cases were presented:

1. <strong>HER2-targeted therapy cardiotoxicity</strong>: A breast cancer patient had fluctuating echocardiographic ejection fraction results that led to interruption of trastuzumab. CMR clarified preserved LV function and showed that CMR is more precise than echo for surveillance. The speakers highlighted that treatment interruptions can worsen cancer outcomes and discussed abbreviated CMR protocols, feature tracking strain, and emerging mapping biomarkers.

2. <strong>Immune checkpoint inhibitor myocarditis</strong>: A patient on ipilimumab/nivolumab developed transaminitis, elevated CK, and marked troponin rise. Echo showed preserved EF, but CMR demonstrated myocarditis features with LGE and elevated native T1. The discussion stressed that checkpoint-inhibitor myocarditis can occur despite normal EF and that CMR is valuable even when echo is unrevealing.

3. <strong>5-FU cardiotoxicity and ischemia risk assessment</strong>: In a high-risk patient with prior MI and bleeding risk, stress perfusion CMR identified inducible ischemia, leading to coronary angiography and PCI before chemotherapy. The case highlighted CMR’s role in assessing coronary risk and guiding safe cancer treatment.

4. <strong>Pericardial constriction after stem cell transplant/GVHD</strong>: A patient developed recurrent heart failure, pericardial effusion, and constrictive physiology. CMR helped confirm pericardial thickening and respiratory septal shift, supporting a diagnosis of constrictive pericarditis related to graft-versus-host disease. Pericardiectomy led to major clinical improvement.

Overall, the webinar emphasized that CMR is underused in cardio-oncology but highly valuable for diagnosis, surveillance, risk stratification, and treatment guidance across multiple cardiotoxicity scenarios.

Keywords

cardiac MRI

CMR

cardio-oncology

trastuzumab cardiotoxicity

HER2-targeted therapy

immune checkpoint inhibitor myocarditis

ipilimumab

nivolumab

5-FU cardiotoxicity

stress perfusion CMR

constrictive pericarditis

graft-versus-host disease