Longitudinal Evaluation of Coronary Arteries and Myocardium in Breast Cancer Using Coronary Computed Tomographic Angiography

IF 12.8 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Cardiovascular imaging Pub Date : 2024-11-01 DOI:10.1016/j.jcmg.2024.05.017

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引用次数: 0

Abstract

Background

The association of coronary computed tomography angiography (CTA) and left ventricular (LV) myocardium measurements with cancer therapy–related cardiac dysfunction (CTRCD) is limited.

Objectives

In this study, the authors sought to evaluate the changes in coronary arteries and LV myocardium in patients with left breast cancer (BC) receiving anthracycline with or without radiotherapy, with the use of coronary CTA.

Methods

Participants with left BC receiving anthracycline with or without radiotherapy were prospectively included. All participants underwent coronary CTA before and after treatment, including nonenhanced calcium-scoring scan, computed tomography angiography, and dual-energy late enhancement scan. Computed tomographic fractional flow reserve (CT-FFR), pericoronary adipose tissue (PCAT) CT attenuation, and LV segments’ extracellular volume (ECV) before and after treatment were compared. Logistic regression analysis was used to assess the association between baseline coronary CTA parameters and CTRCD.

Results

Eighty participants receiving anthracycline and 59 participants receiving anthracycline with radiotherapy were included. CT-FFR decreased and PCAT CT attenuation and LV global and segments’ ECV increased after treatment (all P < 0.05). After chemoradiotherapy, CT-FFR was lower and PCAT CT attenuation and LV myocardial ECV were higher than after chemotherapy. Twenty-four participants developed CTRCD. After adjustment by Heart Failure Association–International Cardio-Oncology Society risk in multivariable logistic regression analysis, baseline stenosis of the left anterior descending artery (LAD) (OR: 1.987 [95% CI: 1.322-2.768]; P = 0.021), left circumflex artery (LCX) (OR: 1.895 [95% CI: 1.281-2.802]; P = 0.031), and right coronary artery (RCA) (OR: 1.920 [95% CI: 1.405-2.811]; P = 0.028), and baseline CT-FFR of the LAD (OR: 3.425 [95% CI: 1.621-9.434]; P < 0.001), LCX (OR: 2.058 [95% CI: 1.030-5.076]; P = 0.006), and RCA (OR: 2.469 [95% CI: 1.232-6.944]; P = 0.004) were associated with CTRCD.

Conclusions

Multiparameter coronary CTA contributes to comprehensive assessment of the coronary arteries and myocardium in patients with left BC receiving anthracycline with or without radiotherapy. Baseline coronary artery stenosis and CT-FFR might be imaging markers for predicting CTRCD in these patients.

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利用冠状动脉计算机断层扫描血管造影术对乳腺癌患者的冠状动脉和心肌进行纵向评估

背景：冠状动脉计算机断层扫描（CTA）和左心室（LV）心肌测量与癌症治疗相关心功能不全（CTRCD）的关联有限：在这项研究中，作者试图利用冠状动脉CTA评估接受或不接受蒽环类放疗的左侧乳腺癌（BC）患者冠状动脉和左心室心肌的变化：方法：前瞻性纳入接受或不接受蒽环类放疗的左侧乳腺癌患者。所有参与者在治疗前后均接受了冠状动脉CTA检查，包括非增强钙离子扫描、计算机断层扫描血管造影和双能晚期增强扫描。比较了治疗前后的计算机断层扫描血流储备（CT-FFR）、冠状动脉周围脂肪组织（PCAT）CT衰减和左心室段细胞外容积（ECV）。采用逻辑回归分析评估基线冠状动脉CTA参数与CTRCD之间的关联：结果：纳入了80名接受蒽环类药物治疗的患者和59名接受蒽环类药物联合放疗的患者。治疗后，CT-FFR下降，PCAT CT衰减和左心室整体及各节段的ECV增加（均P<0.05）。与化疗后相比，放疗后CT-FFR降低，PCAT CT衰减和左心室心肌ECV升高。24名参与者出现了CTRCD。802]；P = 0.031）、右冠状动脉（RCA）（OR：1.920 [95% CI：1.405-2.811]；P = 0.028）和 LAD 的基线 CT-FFR（OR：3.425 [95% CI：1.621-9。434]；P < 0.001）、LCX（OR：2.058 [95% CI：1.030-5.076]；P = 0.006）和 RCA（OR：2.469 [95% CI：1.232-6.944]；P = 0.004）与 CTRCD 相关：多参数冠状动脉CTA有助于全面评估接受或不接受蒽环类放疗的左侧BC患者的冠状动脉和心肌。基线冠状动脉狭窄和CT-FFR可能是预测这些患者CTRCD的影像标记。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Cardiovascular imaging CARDIAC & CARDIOVASCULAR SYSTEMS-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

24.90

自引率

5.70%

发文量

330

审稿时长

4-8 weeks

期刊介绍： JACC: Cardiovascular Imaging, part of the prestigious Journal of the American College of Cardiology (JACC) family, offers readers a comprehensive perspective on all aspects of cardiovascular imaging. This specialist journal covers original clinical research on both non-invasive and invasive imaging techniques, including echocardiography, CT, CMR, nuclear, optical imaging, and cine-angiography. JACC. Cardiovascular imaging highlights advances in basic science and molecular imaging that are expected to significantly impact clinical practice in the next decade. This influence encompasses improvements in diagnostic performance, enhanced understanding of the pathogenetic basis of diseases, and advancements in therapy. In addition to cutting-edge research,the content of JACC: Cardiovascular Imaging emphasizes practical aspects for the practicing cardiologist, including advocacy and practice management.The journal also features state-of-the-art reviews, ensuring a well-rounded and insightful resource for professionals in the field of cardiovascular imaging.