Chunrong Tu MD , Hesong Shen MD , Xiaoqin Li BS, Xing Wang BS, Zhiming Miao BS, Wei Deng BS, Renwei Liu BS, Xiaosong Lan MD, Huifang Chen BS, Jiuquan Zhang PhD
{"title":"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","authors":"Chunrong Tu MD , Hesong Shen MD , Xiaoqin Li BS, Xing Wang BS, Zhiming Miao BS, Wei Deng BS, Renwei Liu BS, Xiaosong Lan MD, Huifang Chen BS, Jiuquan Zhang PhD","doi":"10.1016/j.jcmg.2024.05.017","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The association of coronary computed tomography angiography<span> (CTA) and left ventricular (LV) myocardium measurements with cancer therapy–related cardiac dysfunction (CTRCD) is limited.</span></div></div><div><h3>Objectives</h3><div>In this study, the authors sought to evaluate the changes in coronary arteries<span> and LV myocardium in patients with left breast cancer (BC) receiving anthracycline with or without radiotherapy, with the use of coronary CTA.</span></div></div><div><h3>Methods</h3><div><span><span>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, </span>computed tomography angiography, and dual-energy late enhancement scan. Computed tomographic </span>fractional flow reserve<span><span> (CT-FFR), pericoronary adipose tissue (PCAT) CT attenuation, and LV segments’ extracellular volume (ECV) before and after treatment were compared. </span>Logistic regression analysis was used to assess the association between baseline coronary CTA parameters and CTRCD.</span></div></div><div><h3>Results</h3><div>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 <em>P <</em><span> 0.05). After chemoradiotherapy<span>, 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]; </span></span><em>P =</em> 0.021), left circumflex artery (LCX) (OR: 1.895 [95% CI: 1.281-2.802]; <em>P =</em><span> 0.031), and right coronary artery (RCA) (OR: 1.920 [95% CI: 1.405-2.811]; </span><em>P =</em> 0.028), and baseline CT-FFR of the LAD (OR: 3.425 [95% CI: 1.621-9.434]; <em>P <</em> 0.001), LCX (OR: 2.058 [95% CI: 1.030-5.076]; <em>P =</em> 0.006), and RCA (OR: 2.469 [95% CI: 1.232-6.944]; <em>P =</em> 0.004) were associated with CTRCD.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":14767,"journal":{"name":"JACC. Cardiovascular imaging","volume":null,"pages":null},"PeriodicalIF":12.8000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Longitudinal Evaluation of Coronary Arteries and Myocardium in Breast Cancer Using Coronary Computed Tomographic Angiography\",\"authors\":\"Chunrong Tu MD , Hesong Shen MD , Xiaoqin Li BS, Xing Wang BS, Zhiming Miao BS, Wei Deng BS, Renwei Liu BS, Xiaosong Lan MD, Huifang Chen BS, Jiuquan Zhang PhD\",\"doi\":\"10.1016/j.jcmg.2024.05.017\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>The association of coronary computed tomography angiography<span> (CTA) and left ventricular (LV) myocardium measurements with cancer therapy–related cardiac dysfunction (CTRCD) is limited.</span></div></div><div><h3>Objectives</h3><div>In this study, the authors sought to evaluate the changes in coronary arteries<span> and LV myocardium in patients with left breast cancer (BC) receiving anthracycline with or without radiotherapy, with the use of coronary CTA.</span></div></div><div><h3>Methods</h3><div><span><span>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, </span>computed tomography angiography, and dual-energy late enhancement scan. Computed tomographic </span>fractional flow reserve<span><span> (CT-FFR), pericoronary adipose tissue (PCAT) CT attenuation, and LV segments’ extracellular volume (ECV) before and after treatment were compared. </span>Logistic regression analysis was used to assess the association between baseline coronary CTA parameters and CTRCD.</span></div></div><div><h3>Results</h3><div>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 <em>P <</em><span> 0.05). After chemoradiotherapy<span>, 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]; </span></span><em>P =</em> 0.021), left circumflex artery (LCX) (OR: 1.895 [95% CI: 1.281-2.802]; <em>P =</em><span> 0.031), and right coronary artery (RCA) (OR: 1.920 [95% CI: 1.405-2.811]; </span><em>P =</em> 0.028), and baseline CT-FFR of the LAD (OR: 3.425 [95% CI: 1.621-9.434]; <em>P <</em> 0.001), LCX (OR: 2.058 [95% CI: 1.030-5.076]; <em>P =</em> 0.006), and RCA (OR: 2.469 [95% CI: 1.232-6.944]; <em>P =</em> 0.004) were associated with CTRCD.</div></div><div><h3>Conclusions</h3><div>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.</div></div>\",\"PeriodicalId\":14767,\"journal\":{\"name\":\"JACC. Cardiovascular imaging\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":12.8000,\"publicationDate\":\"2024-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JACC. Cardiovascular imaging\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S1936878X24002298\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JACC. Cardiovascular imaging","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1936878X24002298","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Longitudinal Evaluation of Coronary Arteries and Myocardium in Breast Cancer Using Coronary Computed Tomographic Angiography
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.
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.
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