Extracellular volume measured by whole body CT scans predicts chronic cardiotoxicity in breast cancer patients treated with neoadjuvant therapies based on anthracyclines: A retrospective study

Introduction

Neoadjuvant chemotherapies for breast cancer (BC) are effective but potentially cardiotoxic, and expose long survivors at risk of chemotherapy-related cardiac dysfunction (CTRCD). Unfortunately, early screening for CTRCD has actual diagnostic limits. Myocardial extracellular volume (mECV) is a radiological marker used in cardiac CT scans and cardiac magnetic resonance for diagnosis and follow-up of CTRCD. It can be measured in whole-body CT (WB-CT) scan, routinely performed in patients at high risk of relapse, to evaluate CTRCD occurrence during oncological follow-up.

Methods

82 WB-CT scans were examined at baseline (T₀) and during oncological follow-up at first year (T₁) and fifth year (T₅) after the end of neoadjuvant treatment. mECV was measured at 1 min (PP) and 5 min (DP) after contrast injection. 31 echocardiograms were retrieved in T₁ to perform a linear correlation between mECV and left ventricular ejection fraction (LVEF).

Results

mECV values in T₀ were similar between the two groups both in PP and in DP. Significant results were found for PP values in T₁ (37.0 % vs 32 %, p = 0.0005) and in T₅ (27.2 % vs 31.2 %, p = 0.025). A cut-off value of 35 % in PP proved significant in T₁ (OR = 12.4, p = 0.004), while mECV was inversely correlated with LVEF both in PP (adj-S = −3.54, adj-p = 0.002) and in DP (adj-S = −2.51, adj-p = 0.0002), suggesting a synergistic action with the age at diagnosis (p < 0.0001, respectively).

Conclusions

WB-CT scans performed during oncological reassessment in patients at high-risk of recurrence could be used for CTRCD screening in cardiovascular low-risk patients, especially in aging patients with mECV values above 35 %.