Am J Cardiovasc Dis 2012;2(4):293-300

Original Article
A novel clinical indicator using cardiac technetium-99m sestamibi kinetics
for evaluating cardiotoxicity in cancer patients treated with multiagent
chemotherapy

Gian Piero Carboni

Nuclear Cardiology Service, Università Campus-Bio Medico di Roma, Italy

Received July 6, 2012; accepted September 25, 2012; Epub October 25, 2012; Published November 15, 2012

Abstract: Background: Multiagent chemotherapy (MCT) has mitochondrial targets. Since technetium-99m-sestamibi (MIBI)
is a marker of mitochondrial metabolism, cardiac MIBI uptake and MIBI washout rate (%WR) may detect MCT-induced
cardiotoxicity. Methods: In 16 cancer patients on MCT for 10 months and in 14 non-cancer controls, cardiac MIBI uptake  
between early (30 min) and delayed (3 hours) post-injection planar images was measured as counts per pixel (cpp). The
MIBI cardiac %WR was also measured. Results: When MCT patients and controls were compared, early and cardiac
delayed MIBI uptake were greater in MCT patients (45 ± 12 cpp vs. 30 ± 4 cpp; p <0.04) and (30 ± 8 cpp vs. 25 ± 2 cpp; p <
0.02), but % WR did not change (12 ± 4% vs. 13 ± 3%; p = ns). However, in the MCT patients, the MIBI cardiac %WR was
more rapid because it was obtained at the same time as in the control patients but from a greater amount of MIBI cardiac
uptake. On 36-months follow-up, only MCT patients died of cardiac death. Overall survival risk parameters, only delayed
cardiac MIBI uptake (Odds ratio = 1.7, p<0.001) and early cardiac MIBI uptake (Odds ratio = 1.2, p<0.02) were found to be
significantly associated with cardiac mortality. Conclusions: In experimental studies, anticancer drugs elicit mitochondrial
membrane hyperpolarization with passive cardiac MIBI uptake. In MCT patients, the increased cardiac MIBI uptake and
rapid %WR compared with controls may reflect mitochondrial membrane dysfunction, pre-clinical cardiotoxicity and thus
poor prognosis. (AJCD1207002).

Keywords: Multiagent chemotherapy (MCT), technetium-99m-sestamibi (MIBI), mitochondrial metabolism, cardiotoxicity,
cancer, multiagent chemotherapy


Address all correspondence to:
Dr. Gian Piero Carboni
Nuclear Cardiology Service
Università Campus-Bio Medico di Roma
Via Alvaro del Portillo, 200. 00124 Roma.
Tel: +396225411634; Fax: +396225411933;
E-mail: g.carboni@unicampus.it
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