123I‐MIBG imaging for detection of anthracycline‐induced cardiomyopathy

Due to improvements in early detection and treatment of malignant disease, the population of cancer survivors is constantly expanding. Cancer survivors are faced with chemotherapy‐related long‐term side effects, including irreversible cardiac injury with risk of heart failure (HF). Numerous antineoplastic regimens are associated with risk of cardiac side effects, but anthracyclines in particular carry a severe risk of cardiotoxicity. Currently, serial echocardiographic evaluation of resting left ventricular ejection fraction (LVEF) is the gold standard for monitoring anthracycline‐induced cardiac side effects from chemotherapy. LVEF measurements are, however, limited by their low sensitivity. A normal LVEF does not exclude cardiotoxicity and declines in LVEF are usually not observed before the occurrence of irreversible cardiomyopathy. Hence, a clinically applicable high‐sensitivity diagnostic tool for early detection of chemotherapy‐related cardiotoxicity is still lacking and alternative non‐invasive imaging modalities are therefore being investigated. ¹²³I‐MIBG is a noradrenaline (NA) analogue used for evaluation of cardiac adrenergic function, including assessment of HF prognosis and evaluation of HF treatment response. However, the role of ¹²³I‐MIBG for monitoring chemotherapy‐related cardiotoxicity is still unclear. Here, we review the value of ¹²³I‐MIBG imaging for early detection and prevention of anthracycline‐induced cardiomyopathy.