使用冠状动脉层学血管造影对乳腺癌冠状动脉和心肌的纵向评估

The association of coronary computed tomography angiography (CTA) and left ventricular (LV) myocardium measurements with cancer therapy-related cardiac dysfunction (CTRCD) is limited.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前瞻性包括带有或不进行放射疗法的左BC接受蒽环类邻苯二霉的参与者。所有参与者在治疗前后都接受了冠状动脉CTA，包括非增强的钙评分扫描，计算机断层扫描血管造影和双能量后期增强扫描。比较了处理前后的计算机断层扫描分数流量储备（CT-FFR），中心脂肪组织（PCAT）CT衰减和LV片段的细胞外体积（ECV）。逻辑回归分析用于评估基线冠状动脉CTA参数与CTRCD的关联。 CT-FFR降低，PCAT CT衰减和LV全球和片段的ECV在治疗后增加（所有P <0.05）。化学放疗后，CT-FFR较低，PCAT CT衰减和LV心肌ECV高于化学疗法后。二十四名参与者开发了CTRCD。在通过心力衰竭调整后，在多变量逻辑回归分析中，内部心脏肿瘤学社会的风险，左前降动脉的基线狭窄（LAD）（OR：1.987 [95％CI：1.322-2.768]; P = 0.021）; p = 0.021）; p = 0.021），左环绕式（LCX）（LCX）（LCX）（LCX）（或：1.1.895 p：1.1.895 c：1.85％ci c。 = 0.031）和右冠状动脉（RCA）（OR：1.920 [95％CI：1.405-2.811]; P = 0.028）和LAD的基线CT-FFR（OR：3.425 [95％CI：1.621-9.434]; P <0.001），LCX（OR LCX（OR：2.058） 1.030-5.076]; p = 0.006）和RCA（OR：2.469 [95％CI：1.232-6.944]; p = 0.004）与CTRCD.Multiparameter Coronary CTA有关，有助于对冠状动脉和肌室的全面评估，而没有剩下的BCC。基线冠状动脉狭窄和CT-FFR可能是预测这些患者CTRCD的成像标记。

The association of coronary computed tomography angiography (CTA) and left ventricular (LV) myocardium measurements with cancer therapy-related cardiac dysfunction (CTRCD) is limited.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.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.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.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.