Myocardial fibrosis and strain impairment in treatment-naïve cancer patients: insights into cancer-related myocardial remodeling from a prospective case–control CMR study

Purpose: Functional and myocardial tissue modifications can occur in treatment-naïve cancer patients, driven by uncontrolled inflammation and neuro-hormonal activation. These mechanisms may result in myocardial alterations that serve as subclinical imaging markers of potential cardiac dysfunction. This study aims to evaluate the role of cardiac magnetic resonance in investigating cancer-associated immune activation and identifying early biomarkers of myocardial damage in treatment-naive cancer patients. Methods: This prospective study enrolled 100 participants, including 50 treatment-naive cancer patients affected by diffuse large B cell lymphoma and 50 age- and gender-matched healthy controls. All participants underwent comprehensive cardiac magnetic resonance imaging before starting chemotherapy. Correlation analysis was conducted to identify differences in myocardial tissue characterization and functional parameter between the two groups. Results: Native T1 values were significantly higher in the cancer cohort compared to controls (1007 ± 29 ms vs. 976 ± 29 ms; p < 0.001), while global longitudinal strain was significantly reduced (− 14 ± 2% vs. − 22 ± 6%; p < 0.001). Correlation analysis identified native T1 as an independent predictor of global longitudinal strain impairment (R = − 0.3; p < 0.05). No significant differences in left ventricular mass were observed, suggesting that myocardial tissue changes may precede structural remodeling. Conclusion: Treatment-naive cancer patients exhibit subclinical myocardial alterations, characterized by elevated native T1 and reduced global longitudinal strain. Cardiac magnetic resonance emerges as a valuable tool for identifying early biomarkers of myocardial dysfunction, offering opportunities for risk stratification and proactive management in cardio-oncology.