Background Cardiac magnetic resonance (CMR) global longitudinal strain and circumferential strain abnormalities have been associated with left ventricular ejection fraction (LVEF) reduction and cardiotoxicity from oncologic therapy. However, few studies have evaluated the associations of strain and cardiovascular outcomes. Objectives To assess CMR circumferential and global longitudinal strain (GLS) correlations with cardiovascular outcomes including myocardial infarction, systolic dysfunction, diastolic dysfunction, arrhythmias and valvular disease in breast cancer patients treated with and without anthracyclines and/or trastuzumab therapy. Methods Breast cancer patients with a CMR from 2013–2017 at Yale New Haven Hospital were included. Patient co-morbidities, medications, and cardiovascular outcomes were obtained from chart review. Biostatistical analyses, including Pearson correlations, competing risk regression model, and competing risk survival curves comparing the two groups were analyzed. Results 116 breast cancer with CMRs were included in our analysis to assess differences between Anthracycline/Trastuzumab (AT) (62) treated versus non anthracycline/trastuzumab (NAT) (54) treated patients in terms of imaging characteristics and outcomes. More AT patients 17 (27.4%) developed systolic heart failure compared to the NAT group 6 (10.9%), p = 0.025. Statin use was associated with a significant reduction in future arrhythmias (HR 0.416; 95% CI 0.229–0.755, p = 0.004). In a sub-group of 13 patients that underwent stress CMR, we did not find evidence of microvascular dysfunction by sub-endocardial/sub-epicardial myocardial perfusion index ratio after adjusting for ischemic heart disease. Conclusions In our study, CMR detected signs of subclinical cardiotoxicity such as strain abnormalities despite normal LV function and abnormal circumferential strain was associated with adverse cardiovascular outcomes such as valvular disease and systolic heart failure. Thus, CMR is an important tool during and after cancer treatment to identity and prognosticate cancer treatment-related cardiotoxicity.

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Quantitative cardiovascular magnetic resonance findings and clinical risk factors predict cardiovascular outcomes in breast cancer patients

Environmental justice (EJ) examines the cumulative and disproportionate burden of hazards on vulnerable populations, including low-income communities of color. EJ scorecards provide constituents with a tool to assess their agencies' stances on environmental issues. Through the development of a 2019–2021 Maryland Agency Scorecard, we tracked agency actions to advance EJ, by focusing attention on five key areas: (1) community engagement; (2) commitment to protect the environment both from past policies and protections for the future; (3) prioritization of those impacted by environmental racism; (4) existing resources toward building environmental literacy; and (5) proactive EJ work. N = 9 agencies were scored on a scale of 0–5, based on the methodology from previous EJ Scorecards such as the California Environmental Justice Alliance and the League of Conservation Voters. The agencies with the strongest performance toward EJ were the Department of the Environment (4.25 points) and the Department of Natural Resources (3.86 points). The weakest performing agencies were the Department of Agriculture (0.8 points) and the Energy Administration (0.83 points). Most agencies demonstrated an upward trend during the scoring period, suggesting that the role scorecards can play in holding agencies accountable. Overall, this scorecard highlighted areas where each of the nine Maryland state agencies can improve their efforts on EJ issues. Collectively, each agency should integrate President Biden's Executive Orders on Justice40 and Racial Equity, respectively, to the state level. Future directions will include biennial applications of the scorecard to track progress over time. 

Holding State Agencies Accountable: The Creation of an Environmental Justice Scorecard for Maryland State Agencies

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Quantitative cardiovascular magnetic resonance findings and clinical risk factors predict cardiovascular outcomes in breast cancer patients

Holding State Agencies Accountable: The Creation of an Environmental Justice Scorecard for Maryland State Agencies