To the Editor We welcome the Viewpoint from Oren et al1 highlighting the importance of ensuring high-quality cardiovascular (CV) imaging for patients living with (or survivors of) breast cancer with breast implants. Patients commonly require functional CV imaging to establish CV safety during or after receiving cancer treatment for screening for cancer treatment–related cardiac dysfunction (CTRCD) in line with available guidelines and consensus statements.2 Echocardiography has long been known to be challenging in patients with breast implants,3 and inaccurate imaging risks not only late detection of potentially life-threatening cardiotoxic effects but also inappropriate withholding of cancer treatments. Alternative imaging modalities are therefore commonly required to ensure accurate diagnosis and appropriate clinical decision-making. Investigation and monitoring of incident CV toxic effects also requires optimal CV noninvasive imaging, and the spectrum of disease demands a multimodality approach, with false-positive results reported in this patient group with both electrocardiography4 and nuclear (single-photon emission computed tomography) imaging.5
Manisty C, Barac A, Lenihan D. No Diagnostic Concerns With Cardiovascular Magnetic Resonance Imaging in Patients With Breast Cancer and Breast Implants. JAMA Cardiol. 2022;7(6):655. doi:10.1001/jamacardio.2022.0565
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