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Etienne Croteau, Jennifer M Renaud, Chadi Ayoub, Terrence D Ruddy and Robert A deKemp
Cardiac oncology is a field that will become increasingly important in clinical practice as we become more effective in treating cancer and those treated with chemotherapy live longer. Potential cardiac toxicity associated with some chemotherapy treatments can cause significant morbidity. Molecular positron emission tomography (PET) to assess cardiac metabolism is a promising technology that could increase our knowledge of chemotherapy-related toxicity in the heart. We review the utility of PET cardiac imaging to evaluate the toxic effects of chemotherapy on metabolism. Free fatty acids, glucose and ketone bodies are major substrates for cardiac energy consumption, and adaptations to their use can occur under differing conditions. Cardiovascular complications of chemotherapy can include direct effects on metabolism as well as injury to myocardial tissue by effects on endothelial function, hypertension or ischemia. Even novel chemotherapies that are designed to be more specific in their actions continue to be associated with cardiotoxicity. Further study is required to understand the effects of cardiotoxicity related to chemotherapy, and to develop techniques for its detection as well as prevention. PET cardiac imaging could be used to assist in the early detection of cardiotoxicity and help guide management clinically. It may offer insights to assist in the development of novel treatments and methods for cardioprotection.