Asymptomatic coronary artery disease and CAC score >0 significantly increased anthracycline-related cardiac dysfunction risk in moderate/high-risk patients, independent of age and comorbidities.
Does the presence of asymptomatic coronary artery disease and CAC > 0 predict cancer therapy-related cardiac dysfunction in patients receiving anthracyclines?
Asymptomatic coronary artery disease and a CAC score greater than zero are significant risk factors for developing cancer therapy-related cardiac dysfunction in patients undergoing anthracycline treatment.
Absolute Event Rate: 0% vs 0%
Abstract Aims Many risk factors for cancer therapy-related cardiovascular toxicity overlap with risk factors for atherosclerosis. According to the ESC 2022 Cardio-Oncology Guidelines, coronary computed tomography angiography and coronary artery calcium score are not recommended as part of routine risk assessment prior to oncological treatment. The aim of this study was to prospectively assess the influence of asymptomatic coronary artery disease on chemotherapy-related cardiac dysfunction in patients with moderate and high risk of cardiovascular toxicity, qualified for anthracycline treatment. Methods In all patients, risk factors were collected, laboratory tests, echocardiography with global longitudinal strain (GLS) assessment and coronary artery tomography with coronary artery calcium score were performed. Results A total of 80 patients were included in the study, of which 77 (96.25%) were followed on average for 11.5 months. The mean age at baseline was 60.5 years and 72 (93.51%) were women. During observation, five patients (6.49%) died, including two due to heart failure and three due to cancer progression. The majority of patients (59, 76.6%) had breast cancer, 11 (14.3%) were diagnosed with sarcoma and 7 (9.1%) with lymphoma. According to the HFA-ICOS risk score, 40 patients (51.9%) were classified as moderate-risk (MR), and 37 patients (48.1%) as high-risk (HR) for cancer therapy-related cardiovascular toxicity. Coronary atherosclerosis was more common in older patients and in patients classified as high risk (p0.001). There was also a significant association between coronary artery stenosis and hypertension, hyperlipidemia, chronic kidney disease, and the level of NT-proBNP. Mild CTRCD occurred in 38 (49.4%) patients, moderate CTRCD was diagnosed in 7 (9.1%) and severe in 3 (3.9%) patients. In the univariate analysis, CTRCD was more common in the high risk group (p=0.005), in patients with coronary artery stenosis (p=0.036), and in patients with CAC score greater than zero (p=0.036). In multivariate analysis, the incidence of CTRCD remains higher in the coronary artery stenosis group, even after adjusting for age, hypertension, and hyperlipidemia. In this study group, the CTRCD rates increased with the HFA-ICOS risk score. Conclusions In moderate and high-risk patients, asymptomatic coronary artery disease on CCTA and a coronary artery calcium score greater than zero were risk factors for the development of cancer therapy-related cardiac dysfunction in the course of anthracycline-based cancer treatment. Furthermore, the HFA-ICOS risk score had a good correlation with the incidence of CTRCD in the present study, which validates this risk score tool in patients treated with anthracycline. It would be advisable to incorporate routine CACs measurements on pretreatment CT scans to gain additional insights into patients' risk profiles and facilitate the prompt initiation of cardioprotective therapy.Correlation between CAS and CTRCD Distribution of CACs in study patients
Borowiec et al. (Sat,) reported a other. Asymptomatic coronary artery disease and CAC score >0 significantly increased anthracycline-related cardiac dysfunction risk in moderate/high-risk patients, independent of age and comorbidities.