Imaging the cardiovascular system in the cancer patient

Josef J. Fox, H. William Strauss

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review


The average age of a cancer patient at diagnosis is 66 years. At the time of diagnosis patients with cancer are likely to have multiple comorbidities. Patients >55 years old have an average of ∼2.9 comorbidities, while cancer patients older than 75 have an average of 4.2 comorbidities. The likelihood of coronary artery disease as a comorbidity increases with patient age. An additional risk factor is limited work capacity; patients who cannot perform at least four metabolic equivalents of work (METS) have an increase in all-cause mortality. Patients with cancer and comorbidities or risk factors such as diabetes, hypertension, smoking history, or limited work capacity should have medical clearance prior to invasive diagnostic procedures, major surgery, mediastinal radiation, and/or administration of potentially cardiotoxic chemotherapy. Information from medical records will permit calculation of a clinical score to define the risk of adverse events as a result of a major diagnostic or surgical procedure. Stress testing with cardiac imaging should be done in patients with an intermediate risk of coronary heart disease, and should be considered in patients with limited work capacity or advanced age. In selected patients, coronary CT angiography or coronary calcium score may be a suitable evaluation. In patients with cancer of the esophagus, breast, lung, melanoma, or lymphoma, chest-CT and 18F-FDG PET/CT studies should be carefully evaluated to detect pericardial or myocardial involvement. Chemotherapy may cause myocardial ischemia due to coronary spasm and/or decreased ventricular function due to irreversible or reversible myocardial damage, as well as repolarization abnormalities, which may result in fatal arrhythmia. Radiotherapy may accelerate the development of atherosclerosis of vessels in the radiation field and cause irreversible damage to myocardium in the radiation field.

Original languageEnglish
Title of host publicationNuclear Oncology
Subtitle of host publicationFrom Pathophysiology to Clinical Applications
PublisherSpringer International Publishing
Number of pages24
ISBN (Electronic)9783031054945
ISBN (Print)9783031054938
StatePublished - 4 Oct 2022
Externally publishedYes


  • Cancer coexisting with cardiovascular disease
  • Cardiotoxic chemotherapy
  • Cardiovascular comorbidities in the cancer patient
  • Heart disease in cancer patients
  • Heart imaging in the cancer patient
  • Stress testing in cancer patients


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