Epicardial fat volume >143 cm3 predicted cardiovascular events with 80% sensitivity and 69% specificity, improving cardiotoxicity risk stratification beyond traditional scores.
Does measuring epicardial fat volume and CAC score improve the prediction of adverse cardiovascular events compared to traditional risk scores in patients with gastrointestinal tumors treated with fluoropyrimidines?
Epicardial fat volume and CAC score derived from routine staging CT scans may improve cardiotoxicity risk stratification beyond traditional clinical scores in patients with gastrointestinal tumors receiving fluoropyrimidines.
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Abstract Background Cardiotoxicity risk stratification before starting antineoplastic treatment in cancer patients is a crucial in order to correct cardiovascular risk factors, optimize the management of concomitant cardiac diseases and thus to reduce the risk of developing cardiovascular complications. The aim of this study was to evaluate the usefulness of epicardial fat and calcium score (CAC score) derived form the routine tumor staging CT, in providing additional information beyond traditional risk scores (HFA/ICOS and SCORE2/2-OP) in the stratification of the risk of cardiotoxicity. Methods An observational study was conducted on patients with gastrointestinal tumors treated with fluopyrimidines, in association or not with VEGF inhibitors. At baseline, medical history, laboratory tests, ECG and echocardiogram were evaluated and the cardiotoxicity risk stratification was evaluated using the SCORE2/2-OP and HFA/ICOS scores. Epicardial fat density and volume (EFV) and the CAC score were also calculated at chest CT. The occurrence cardiovascular adverse events was reported during follow up. Results 54 patients were enrolled, (M:F = 32: 22, median age 69 range years 61-76). After a median follow up period of 9.5 months, 25 adverse cardiovascular events occurred. The baseline SCORE2/2-OP (AUC 0.52) and HFA/ICOS (AUC 0.52) were not accurate predictors of adverse cardiovascular events. EFV (AUC 0.68) and CAC (AUC 0.65) were better predictors. An EFV143 cm3 was found to have the highest sensitivity (80%) and specificity (69%) in predicting cardiovascular events. The most accurate method for predicting adverse cardiovascular events in our population was found to be the association of the HFA/ICOS score with baseline EFV. Conclusion Traditional risk scores SCORE2/2-OP and HFA/ICOS were not accurate predictors of cardiotoxicity risk in cancer patients treated with fluoropyrimidines, when used individually. CAC score and EFV were better predictors of adverse cardiovascular events. In particular, EFV seemed to implement risk stratification evaluated by HFA/ICOS. An EFV value 143 cm3 demonstrated the best sensitivity and specificity in predicting events. Measuring EFV at the routine CT scan for tumor staging could improve the accuracy of traditional score for predicting cardiotoxicity risk in cancer treated with fluoropyrimidines. Larger prospective studies are needed to confirm our results.
Lisi et al. (Sat,) reported a other. Epicardial fat volume >143 cm3 predicted cardiovascular events with 80% sensitivity and 69% specificity, improving cardiotoxicity risk stratification beyond traditional scores.