使用冠状动脉CT血管造影对乳腺癌患者冠状动脉和心肌的纵向评估

冠状动脉CT血管造影（CTA）与左心室（LV）心肌测量的相关性及其在癌症治疗相关心脏功能障碍（CTRCD）中的作用有限。在本研究中，作者旨在利用冠状动脉CTA评估接受蒽环类药物±放疗的左乳腺癌（BC）患者冠状动脉和LV心肌的变化。前瞻性纳入接受蒽环类药物±放疗的左乳腺癌患者。所有患者在治疗前后均接受冠状动脉CTA，包括非增强钙评分扫描、血管造影和双能量晚期增强扫描。比较了治疗前后的冠状动脉血流储备分数（CT-FFR）、心包冠状动脉脂肪组织（PCAT）CT衰减以及LV心肌的细胞外体积（ECV）。采用逻辑回归分析评估基线冠状动脉CTA参数与CTRCD的关系。共纳入80名蒽环类药物患者和59名接受蒽环类药物+放疗的患者。结果显示，治疗后CT-FFR下降，PCAT CT衰减和LV心肌ECV升高（全部P < .05）。放疗后，CT-FFR更低，PCAT CT衰减和LV心肌ECV更高。24名患者发生了CTRCD。多变量逻辑回归校正心脏衰竭国际心脏肿瘤学会（Heart Failure Association-International Cardio-Oncology Society）风险后，基线左前降支（LAD）狭窄（OR：1.987，95% CI：1.322-2.768，P = 0.021）、左旋支（LCX）（OR：1.895，95% CI：1.281-2.802，P = 0.031）和右冠状动脉（RCA）（OR：1.920，95% CI：1.405-2.811，P = 0.028），以及基线LAD的CT-FFR（OR：3.425，95% CI：1.621-9.434，P < .001）、LCX（OR：2.058，95% CI：1.030-5.076，P = 0.006）和RCA（OR：2.469，95% CI：1.232-6.944，P = 0.004）均与CTRCD相关。多参数冠状动脉CTA有助于全面评估接受蒽环类药物±放疗的左乳腺癌患者的冠状动脉和心肌。基线冠状动脉狭窄和CT-FFR可能作为预测CTRCD的影像学标志物。

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.