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Hi guys! I’m kind of in the mood to give a talk this night. So why not talk about #CardioOnc & #whyCMR? #CardioTwitter #JACCCardioOnc 
We started our small “shop” in mid 2013, with the help of @DipanJShah, he allowed me to start a small CMR practice at @HMethodistCV. I did that until we got #CardsRads right, then @XRayDUG supported me and I was able to practice CMR at MD Anderson, then our volumes have been ⬆️
In 2017, when we got +300, I got so happy, that we wrote about our CMR experience in a major cancer center. Jon Weinsaft had a great practice at MSK already, so we couldn’t claim it was the first CMR practice in a major cancer center, still we were very happy about it.
But #CardioOnc is the perfect niche to grow a CMR practice because of all cardiotoxicity concerns. Many AUC apply concerning to our practice such as cardiomyopathy, cardiac masses, etc.
LVEF is still the parameter that defines cardiotoxicity. Echo does a good job of excluding cardiotoxicity in many cases. Issues of technical aspect need further verification with either UEA (contrast) or another modality. But CMR can do LVEF better plus assess etiology of CMP.
Nice study by @cshenoy3 showing discrepancies of CMR & MUGA in cases for which there was suspicion of cardiotoxicity. Wide LOA when MUGA is compared to CMR. So MUGA not that great, plus radiation exposure limits technique for follow up assessment.
It goes without saying that LGE helps us in identifying certain cardiomyopathies and gives us excellent prognostic info. With immune checkpoint inhibitors it can help us in identifying myocarditis given LVEF>50% in half cases of ICI myocarditis. Echo may miss this.
Highly prognostic in cardiac AL & TTR amyloidosis. Better than Echo+EKG combined. Cardiac amyloidosis is becoming part of #CardioOnc
T2* under-utilised in most centers. Helps in identifying iron overload in myocardium and start earlier tx with chelation agents. A must in transfusion dependent patients with low LVEF de novo.
Putting it all together, parametric imaging has a huge role in #CardioOnc. Cardiomyopathy is an important indication for CMR in #CardioOnc & use is very helpful to determine the clinical path & etiology of cardiomyopathy
