Coronary artery calcium score and other risk factors in patients at moderate and high risk of cancer therapy-related cardiovascular toxicity.
Anthracycline
Cancer therapy-related cardiovascular toxicity
Cardiovascular toxicity risk factors
Computed tomography
Coronary artery calcium score
Hyperlipidaemia
Journal
Cardio-oncology (London, England)
ISSN: 2057-3804
Titre abrégé: Cardiooncology
Pays: England
ID NLM: 101689938
Informations de publication
Date de publication:
28 Sep 2024
28 Sep 2024
Historique:
received:
23
07
2024
accepted:
16
09
2024
medline:
29
9
2024
pubmed:
29
9
2024
entrez:
28
9
2024
Statut:
epublish
Résumé
The presence and burden of coronary artery calcium (CAC) is a strong predictor of cardiovascular events. Current guidelines of the European Society of Cardiology (ESC) for cardio-oncology do not recommend the use of the CAC score to determine the status of risk in cancer patients. The aim of this study is to evaluate the presence and burden of CAC on cardiac tomography and the distribution of the cardiovascular toxicity risk factors in patients with moderate and high baseline risk of cancer therapy-related cardiovascular toxicity. The study prospectively included cancer patients, diagnosed and qualified for systemic treatment with anthracycline chemotherapy. Clinical data and blood samples were collected from all patients. Additionally, the echocardiography and coronary computed tomography (CCTA) with the calculation of the coronary artery calcium (CAC) score were performed. A total of 80 patients (mean age 60.5 years, 75 female) were included in the study. The majority of patients (62, 77.5%) had breast cancer, 11 (13.8%) were diagnosed with sarcoma, and 7 (8.8%) with lymphoma. There were 42 (52.5%) patients classified as having moderate (MR) and 38 (47.5%) as having high risk (HR) of cancer therapy-related cardiovascular toxicity according to current ESC guidelines. In comparison with moderate risk, high risk patients were older and more likely to have hypertension, hyperlipidaemia and chronic kidney disease. The mean coronary artery calcium score was significantly higher in the HR group (150.4 vs. 24.8; p = 0.000). Furthermore, cardiac biomarkers were also higher in high-risk patients (p = 0.000). In echocardiographic parameters global longitudinal strain (GLS) was lower (p = 0.012), and diastolic dysfunction was more common in the HR group. However, the left ventricle ejection fraction (LVEF) was similar in the MR and HR groups. In patients at high and moderate risk for cancer therapy-related cardiovascular toxicity, cardiovascular toxicity risk factors were common and more prevalent in the high-risk group. The coronary artery calcium score was also significantly higher in the high-risk group. Assessing the presence and burden of coronary artery calcium is an attractive option to assess additional cardiovascular risk in cancer patients.
Sections du résumé
BACKGROUND
BACKGROUND
The presence and burden of coronary artery calcium (CAC) is a strong predictor of cardiovascular events. Current guidelines of the European Society of Cardiology (ESC) for cardio-oncology do not recommend the use of the CAC score to determine the status of risk in cancer patients. The aim of this study is to evaluate the presence and burden of CAC on cardiac tomography and the distribution of the cardiovascular toxicity risk factors in patients with moderate and high baseline risk of cancer therapy-related cardiovascular toxicity.
METHODS
METHODS
The study prospectively included cancer patients, diagnosed and qualified for systemic treatment with anthracycline chemotherapy. Clinical data and blood samples were collected from all patients. Additionally, the echocardiography and coronary computed tomography (CCTA) with the calculation of the coronary artery calcium (CAC) score were performed.
RESULTS
RESULTS
A total of 80 patients (mean age 60.5 years, 75 female) were included in the study. The majority of patients (62, 77.5%) had breast cancer, 11 (13.8%) were diagnosed with sarcoma, and 7 (8.8%) with lymphoma. There were 42 (52.5%) patients classified as having moderate (MR) and 38 (47.5%) as having high risk (HR) of cancer therapy-related cardiovascular toxicity according to current ESC guidelines. In comparison with moderate risk, high risk patients were older and more likely to have hypertension, hyperlipidaemia and chronic kidney disease. The mean coronary artery calcium score was significantly higher in the HR group (150.4 vs. 24.8; p = 0.000). Furthermore, cardiac biomarkers were also higher in high-risk patients (p = 0.000). In echocardiographic parameters global longitudinal strain (GLS) was lower (p = 0.012), and diastolic dysfunction was more common in the HR group. However, the left ventricle ejection fraction (LVEF) was similar in the MR and HR groups.
CONCLUSIONS
CONCLUSIONS
In patients at high and moderate risk for cancer therapy-related cardiovascular toxicity, cardiovascular toxicity risk factors were common and more prevalent in the high-risk group. The coronary artery calcium score was also significantly higher in the high-risk group. Assessing the presence and burden of coronary artery calcium is an attractive option to assess additional cardiovascular risk in cancer patients.
Identifiants
pubmed: 39342402
doi: 10.1186/s40959-024-00266-6
pii: 10.1186/s40959-024-00266-6
doi:
Types de publication
Journal Article
Langues
eng
Pagination
64Subventions
Organisme : Research grant from the Polish Cardiac Society in cooperation with Servier
ID : 80/2021
Informations de copyright
© 2024. The Author(s).
Références
Lyon AR, Lopez-Fernandez T, Couch LS, Asteggiano R, Aznar MC, Bergler-Klein J, et al. 2022 ESC guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J Cardiovasc Imaging. 2022;23(10):e333–465.
doi: 10.1093/ehjci/jeac106
pubmed: 36017575
Mukai M, Komori K, Oka T. Mechanism and management of Cancer Chemotherapy-Induced atherosclerosis. J Atheroscler Thromb. 2018;25(10):994–1002.
doi: 10.5551/jat.RV17027
pubmed: 30224607
pmcid: 6193189
Jemal A, Ward EM, Johnson CJ, Cronin KA, Ma J, Ryerson B et al. Annual Report to the Nation on the Status of Cancer, 1975–2014, Featuring Survival. J Natl Cancer Inst. 2017;109(9).
Herrmann J, Lenihan D, Armenian S, Barac A, Blaes A, Cardinale D, et al. Defining cardiovascular toxicities of cancer therapies: an International Cardio-Oncology Society (IC-OS) consensus statement. Eur Heart J. 2022;43(4):280–99.
doi: 10.1093/eurheartj/ehab674
pubmed: 34904661
Acar Z, Kale A, Turgut M, Demircan S, Durna K, Demir S, et al. Efficiency of atorvastatin in the protection of anthracycline-induced cardiomyopathy. J Am Coll Cardiol. 2011;58(9):988–9.
doi: 10.1016/j.jacc.2011.05.025
pubmed: 21851890
Abdel-Qadir H, Bobrowski D, Zhou LM, Austin PC, Calvillo-Argüelles O, Amir E et al. Statin exposure and risk of heart failure after anthracycline- or trastuzumab-based chemotherapy for early breast Cancer: a propensity score-matched cohort study. J Am Heart Association. 2021;10(2).
Seicean S, Seicean A, Plana JC, Budd GT, Marwick TH. Effect of statin therapy on the risk for incident heart failure in patients with breast cancer receiving anthracycline chemotherapy: an observational clinical cohort study. J Am Coll Cardiol. 2012;60(23):2384–90.
doi: 10.1016/j.jacc.2012.07.067
pubmed: 23141499
Chotenimitkhun R, D’Agostino R Jr., Lawrence JA, Hamilton CA, Jordan JH, Vasu S, et al. Chronic statin administration may attenuate early anthracycline-associated declines in left ventricular ejection function. Can J Cardiol. 2015;31(3):302–7.
doi: 10.1016/j.cjca.2014.11.020
pubmed: 25662284
Nabati M, Janbabai G, Esmailian J, Yazdani J. Effect of Rosuvastatin in preventing Chemotherapy-Induced cardiotoxicity in women with breast Cancer: a Randomized, Single-Blind, placebo-controlled trial. J Cardiovasc Pharmacol Ther. 2019;24(3):233–41.
doi: 10.1177/1074248418821721
pubmed: 30599756
Shahid I, Yamani N, Ali A, Kumar P, Figueredo V, Unzek S, et al. Meta-analysis evaluating the Use of statins to attenuate cardiotoxicity in Cancer patients receiving anthracyclines and Trastuzumab-based Chemotherapy. Am J Cardiol. 2021;156:142–5.
doi: 10.1016/j.amjcard.2021.07.001
pubmed: 34362551
Ties D, Pundziute G, van der Aalst C, van der Bilt I, Braam R, Gratama JW, et al. Prevalence of obstructive coronary artery disease in asymptomatic individuals with increased coronary artery calcium scores. Circulation. 2021;144(25):E575–E.
Taylor AJ, Bindeman J, Feuerstein I, Cao F, Brazaitis M, O’Malley PG. Coronary calcium independently predicts incident premature coronary heart disease over measured cardiovascular risk factors: mean three-year outcomes in the Prospective Army Coronary Calcium (PACC) project. J Am Coll Cardiol. 2005;46(5):807–14.
doi: 10.1016/j.jacc.2005.05.049
pubmed: 16139129
Budoff MJ, Shaw LJ, Liu ST, Weinstein SR, Mosler TP, Tseng PH, et al. Long-term prognosis associated with coronary calcification: observations from a registry of 25,253 patients. J Am Coll Cardiol. 2007;49(18):1860–70.
doi: 10.1016/j.jacc.2006.10.079
pubmed: 17481445
Hooks M, Sandhu G, Maganti T, Chen KA, Wang M, Cullen R, et al. Incidental coronary calcium in cancer patients treated with anthracycline and/or trastuzumab. Eur J Prev Cardiol. 2022;29(17):2200–10.
doi: 10.1093/eurjpc/zwac185
pubmed: 36017793
Brann AM, Bai CJ, Hibbeln JF, Williams KA, Okwuosa TM. A comparative assessment of coronary artery calcification on chest CT scans of patients referred to a cardio-oncology clinic. Cardiooncology. 2016;2(1):7.
pubmed: 33530143
pmcid: 7837139
Gernaat SA, Isgum I, de Vos BD, Takx RA, Young-Afat DA, Rijnberg N, et al. Automatic Coronary Artery Calcium Scoring on Radiotherapy Planning CT scans of breast Cancer patients: Reproducibility and Association with Traditional Cardiovascular Risk factors. PLoS ONE. 2016;11(12):e0167925.
doi: 10.1371/journal.pone.0167925
pubmed: 27936125
pmcid: 5148008
Kim K, Chung SY, Oh C, Cho I, Kim KH, Byun HK, et al. Automated coronary artery calcium scoring in patients with breast cancer to assess the risk of heart disease following adjuvant radiation therapy. Breast. 2022;65:77–83.
doi: 10.1016/j.breast.2022.07.003
pubmed: 35870419
pmcid: 9307671
Patel S, Franco FX, McDonald M, Rivera C, Perez-Villa B, Collier P, et al. Use of computed tomography coronary calcium score for prediction of cardiovascular events in cancer patients: a retrospective cohort analysis. Cardiooncology. 2024;10(1):1.
pubmed: 38167231
pmcid: 10759457
Phillips WJ, Johnson C, Law A, Turek M, Small AR, Inacio JR, et al. Reporting of coronary artery calcification on chest CT studies in breast cancer patients at high risk of cancer therapy related cardiac events. Int J Cardiol Heart Vasc. 2018;18:12–6.
pubmed: 29750180
pmcid: 5941242
Wang FM, Reiter-Brennan C, Dardari Z, Marshall CH, Nasir K, Miedema MD, et al. Association between coronary artery calcium and cardiovascular disease as a supporting cause in cancer: the CAC consortium. Am J Prev Cardiol. 2020;4:100119.
doi: 10.1016/j.ajpc.2020.100119
pubmed: 34327479
pmcid: 8315471
Borowiec A, Ozdowska P, Rosinska M, Jagiello-Gruszfeld A, Jasek S, Waniewska J, et al. Prognostic value of coronary atherosclerosis and CAC score for the risk of chemotherapy-related cardiac dysfunction (CTRCD): the protocol of ANTEC study. PLoS ONE. 2023;18(8):e0288146.
doi: 10.1371/journal.pone.0288146
pubmed: 37590267
pmcid: 10434956
Lopez-Mattei J, Yang EH, Baldassarre LA, Agha A, Blankstein R, Choi AD, et al. Cardiac computed tomographic imaging in cardio-oncology: an expert consensus document of the Society of Cardiovascular Computed Tomography (SCCT). Endorsed by the International Cardio-Oncology Society (ICOS). J Cardiovasc Comput Tomogr. 2023;17(1):66–83.
doi: 10.1016/j.jcct.2022.09.002
pubmed: 36216699
Martin SS, Blaha MJ, Blankstein R, Agatston A, Rivera JJ, Virani SS, et al. Dyslipidemia, coronary artery calcium, and incident atherosclerotic cardiovascular disease: implications for statin therapy from the multi-ethnic study of atherosclerosis. Circulation. 2014;129(1):77–86.
doi: 10.1161/CIRCULATIONAHA.113.003625
pubmed: 24141324
Shen H, Lian Y, Yin J, Zhu M, Yang C, Tu C et al. Cardiovascular Risk Stratification by Automatic Coronary Artery Calcium Scoring on Pretreatment Chest Computed Tomography in Diffuse Large B-Cell Lymphoma Receiving Anthracycline-Based Chemotherapy: A Multicenter Study. Circulation: Cardiovascular Imaging. 2023;16(2).
Camilli M, Bisceglia I, Canale ML, Turazza FM, De Luca L, Gabrielli D, et al. Screening and management of dyslipidemia in oncologic patients undergoing cardiotoxic therapies: results from an Italian survey. Cardiooncology. 2023;9(1):32.
pubmed: 37542355
pmcid: 10403947
Caro-Codon J, Lopez-Fernandez T, Alvarez-Ortega C, Zamora Aunon P, Rodriguez IR, Gomez Prieto P, et al. Cardiovascular risk factors during cancer treatment. Prevalence and prognostic relevance: insights from the CARDIOTOX registry. Eur J Prev Cardiol. 2022;29(6):859–68.
doi: 10.1093/eurjpc/zwaa034
pubmed: 33624069
Suntheralingam S, Fan C-PS, Calvillo-Argüelles O, Abdel-Qadir H, Amir E, Thavendiranathan P. Evaluation of risk prediction models to identify Cancer therapeutics related Cardiac Dysfunction in Women with HER2 + breast Cancer. J Clin Med. 2022;11(3):847.
doi: 10.3390/jcm11030847
pubmed: 35160296
pmcid: 8836544
Pontone G, Rossi A, Guglielmo M, Dweck MR, Gaemperli O, Nieman K, et al. Clinical applications of cardiac computed tomography: a consensus paper of the European Association of Cardiovascular Imaging-part II. Eur Heart J Cardiovasc Imaging. 2022;23(4):e136–61.
doi: 10.1093/ehjci/jeab292
pubmed: 35175348
pmcid: 8944330
Calvillo-Argüelles O, Abdel-Qadir H, Michalowska M, Billia F, Suntheralingam S, Amir E, et al. Cardioprotective effect of statins in patients with HER2-Positive breast Cancer receiving Trastuzumab Therapy. Can J Cardiol. 2019;35(2):153–9.
doi: 10.1016/j.cjca.2018.11.028
pubmed: 30760421
Kim J, Nishimura Y, Kewcharoen J, Yess J. Statin Use can attenuate the decline in Left Ventricular Ejection Fraction and the incidence of Cardiomyopathy in Cardiotoxic Chemotherapy recipients: a systematic review and Meta-analysis. J Clin Med. 2021;10(16).
Neilan TG, Quinaglia T, Onoue T, Mahmood SS, Drobni ZD, Gilman HK, et al. Atorvastatin for Anthracycline-Associated Cardiac Dysfunction: the STOP-CA Randomized Clinical Trial. JAMA. 2023;330(6):528–36.
doi: 10.1001/jama.2023.11887
pubmed: 37552303
pmcid: 10410476