使用冠状动脉计算机断层扫描血管造影对乳腺癌的冠状动脉和心肌进行纵向评估。
Longitudinal Evaluation of Coronary Arteries and Myocardium in Breast Cancer Using Coronary Computed Tomographic Angiography.
发表日期:2024 Jun 27
作者:
Chunrong Tu, Hesong Shen, Xiaoqin Li, Xing Wang, Zhiming Miao, Wei Deng, Renwei Liu, Xiaosong Lan, Huifang Chen, Jiuquan Zhang
来源:
JACC-Cardiovascular Imaging
摘要:
冠状动脉计算机断层扫描血管造影 (CTA) 和左心室 (LV) 心肌测量与癌症治疗相关的心功能障碍 (CTRCD) 的关联有限。在这项研究中,作者试图评估患者冠状动脉和 LV 心肌的变化左乳腺癌 (BC) 接受蒽环类药物联合或不联合放疗,并使用冠状动脉 CTA。前瞻性纳入接受蒽环类药物联合或不联合放疗的左侧 BC 参与者。所有参与者在治疗前后均接受冠状动脉CTA检查,包括非增强钙评分扫描、计算机断层扫描血管造影和双能后期增强扫描。比较治疗前后的计算机断层血流储备分数(CT-FFR)、冠状动脉周围脂肪组织(PCAT)CT衰减以及左心室节段的细胞外容积(ECV)。 Logistic回归分析用于评估基线冠状动脉CTA参数与CTRCD之间的关联。包括80名接受蒽环类药物治疗的受试者和59名接受蒽环类药物联合放疗的受试者。治疗后 CT-FFR 降低,PCAT CT 衰减以及 LV 整体和节段的 ECV 增加(所有 P < 0.05)。放化疗后,CT-FFR 低于化疗后,PCAT CT 衰减和左心室心肌 ECV 高于化疗后。 24 名参与者开发了 CTRCD。经过心力衰竭协会-国际心脏肿瘤学会多变量逻辑回归分析中的风险调整后,左前降支 (LAD) 基线狭窄(OR:1.987 [95% CI:1.322-2.768];P = 0.021),左回旋动脉 (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),和 LAD 的基线 CT-FFR(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)和 RCA( OR:2.469 [95% CI:1.232-6.944];P = 0.004)与 CTRCD 相关。多参数冠状动脉 CTA 有助于对接受或不接受蒽环类放疗的左侧 BC 患者的冠状动脉和心肌进行综合评估。基线冠状动脉狭窄和 CT-FFR 可能是预测这些患者 CTRCD 的影像学标志。版权所有 © 2024 美国心脏病学会基金会。由爱思唯尔公司出版。保留所有权利。
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.Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.