Page 47 - PMCC on the Globe and Mail - 2016 Edition

stop further injury.”
Mrs. Vargas was invited to be
part of the study.
“She’s a sweetheart and
incredibly, eternally optimistic,”
says PMCC Nurse Practitioner
Linda Belford, who is part of the
EMBRACE-MRI team following
Mrs. Vargas. “I think her husband
does all the worrying.”
Participants who have
volunteered for EMBRACE-MRI
are seen every three months for
routine clinical echocardiograms
and blood work and a research
heart MRI.
Mrs. Vargas was already being
followed in the study when
she started experiencing heart
problems.
“I was kind of worried because
her heart rate was really going up,”
recalls her husband. “It would go
as fast as 130 [beats per minute]
sitting down and that’s not
normal.”
Dr. Thavendiranathan and his
team responded quickly.
“That’s why we’re here,” says
Ms. Belford. “Our responsibility
to patients is to provide timely
access. These are the kinds of
things that make a difference.”
Dr. Thavendiranathan explains:
“When she came back for the first
follow-up, we saw the first small
change in heart function. We were
worried enough that we brought
her back one month later. She was
complaining of severe shortness of
breath and a fast heart rate – what
would be classified as cardiac
toxicity. We made changes to
her treatment and added heart
protective medications.
“If we hadn’t intervened, her
cancer treatment may have been
stopped.”
Mrs. Vargas recalls one incident
in particular, while she was
receiving her chemotherapy
treatments at St. Michael’s
Hospital in Toronto.
“One time I was in the chair,”
she says, “and we weren’t sure
whether I should be receiving the
chemo or not. I called Dr. Dinesh,
01 Elenita Vargas continues
to be part of an important
EMBRACE-MRI clinical
research study
at PMCC.
02 Dr. Dinesh
Thavendiranathan and Nurse
Practitioner Linda Belford are
key players in the EMBRACE-
MRI team following Mrs.
Vargas’ progress.
Winter 2017
“One of
the biggest
challenges in
cardio-oncology
is that the
symptoms of
cancer treatment
overlap with
the symptoms
of the cardiac
effect of cancer
treatment.”
Dr. Paaladinesh (Dinesh)
Thavendiranathan,
PMCC cardiologist
and he answered the phone
himself. He said I should go ahead and inflammation,” says
with the treatment.
“I am always reluctant to phone
him unless it’s an emergency
because he is so busy, but I am
confident that he will always
answer the phone.”
While it’s too late for Mrs.
Vargas, another clinical trial
at the TRCHR, part of an
international study, is looking at Joint Department of Medical
whether using drugs such as beta
blockers and ACE inhibitors when
subtle changes to heart function
are seen by echocardiography
could protect the heart from
cancer treatment-related heart
function. “Research is ongoing as
to whether or not pretreatment
with beta blockers and ACE-I will
mitigate cardiotoxicity,” says Ms.
Belford. “These cancer patients
are dehydrated and experiencing
fatigue. Beta blockers or other
preventive drugs might make
them feel worse with an unclear
benefit,” she says.
“We’re trying to get closer to
get risk prediction models to
treat those who will benefit the
most, and that’s also why we’re
looking at genomes as part of the
EMBRACE-MRI study.”
In the meantime, the knowledge,
research and technology at the
TRCHR have made it possible
for women like Elenita Vargas to
continue their life-saving cancer
treatments, while preventing
debilitating damage to their
hearts.
02
PET/MRi TRaCks inflaMMaTion and CEll
MigRaTion, giving REsEaRCHERs nEw insigHTs
inTo THE woRking HEaRT
Cardiologists, radiologists and
basic scientists at the Ted Rogers
Centre for Heart Research
(TRCHR), part of the Peter Munk
Cardiac Centre (PMCC), are
understandably excited about a
sophisticated, game-changing
technological marvel that arrived
in their midst over the summer.
Significant advances in cardiac
MRI can identify swelling
PMCC cardiologist Dr. Dinesh
Thavendiranathan. The new PET/
MRI cylotron machine offers even
more insight into the working
heart.
“We can identify changes
regarding inflammation or cell
migration by PET and correlate
it with functional data from
an MRI,” explains PMCC and
Imaging Radiologist Dr. Bernd
Wintersperger.
“Now we can measure flow
direction and velocity in the
vessels– how hard blood is
pounding into the wall – and
simultaneously get information
about the wall tissue.”
The new machine also provides
measures of arterial stiffness and Princess Margaret Cancer Centre].”
vascular function – how hard
the pulse hits all the peripheral
vessels. “Many people think that
changes in the cardiovascular
system play an important role
in dementia and those changes
in the brain as well,” says Dr.
Wintersperger.
Located in a room next to the
PET/MRI machine is the UHN
cyclotron facility. The cylotron is
used to produce radioisotopes
for PET imaging. The proximity
of the PET/MRI to the cyclotron
enables imaging using short-lived
radioisotopes (some of which have
a half life of only a few minutes),
which otherwise would not be
possible. This offers a unique
advantage to both patients and
their clinicians and expands the
research opportunities.
While the PET/MRI offers valuable
insights into many aspects of heart
dysfunction, its role in identifying
predictors of damage from cancer
treatment will be paramount.
That’s because the TRCHR is at
the forefront of cardiac research
and cardio-oncology research
not just in Canada, but also in the
world.
“We have the largest heart
failure program in the country,”
says PMCC Cardiologist
Dr. Diego Delgado, “and we are
across the street from one of the
largest oncology and hematology
institutions in the world [the
As part of the University Health
Network, and next door to the
MaRS Innovation research centre,
he notes, “we have access to
clinical trials and new drugs. We
are leaders in this area.” •
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