Applications of Cardiac Computed Tomography in the Cardio-Oncology Population

Abstract

Opinion statementThe increased risk for cardiovascular events in aging cancer survivors and those undergoing certain chemotherapeutic treatments has raised concern for more rigorous screening and surveillance methods above that of the general population. At this time, there are limited guidelines for how to best manage this vulnerable cohort. Questions regarding timing of screening, choice of imaging modality and risk reduction strategies-especially in those patients with known atherosclerotic disease-remain to be elucidated. Over a decade of case series, retrospective studies and clinical trials have shed light on the evolving role of cardiac computed tomography (CT) in this population, of which there is a relative paucity of data regarding its potential utility in the specific cardio-oncology population. Focusing on ability of cardiac CT to evaluate multiple cardiac and vascular structures, provide diagnostic and prognostic information, as well as assist interventional and surgical colleagues in surgical/percutaneous valve replacement and revascularization strategies is the premise for this review.

British Society for Echocardiography and British Cardio-Oncology Society guideline for transthoracic echocardiographic assessment of adult cancer patients receiving anthracyclines and/or trastuzumab

“…Low inter- and intrareader variability make it the optimal technique for detecting small changes in LVEF in serial scans; however, its use is still limited by its availability and cost ( 63 , 64 ). The role of cardiac CT is mainly in the noninvasive evaluation of coronary artery disease, but it can also be used to assess pericardial disease and valvular heart disease and in the imaging of cardiac tumors ( 65 , 66 ).…”

Breast Radiotherapy-Related Cardiotoxicity. When, How, Why. Risk Prevention and Control Strategies

“…However, in-depth knowledge of the biological mechanisms involved in RIHD is needed [113] to develop new non-invasive detection methods for diagnosis and follow-up. We need to identify specific biomarkers of RT-induced injury [64], to implement high-resolution imaging techniques in daily practice [114][115][116], and to combine the use of omics data with molecular imaging (single-photon emission computed tomography (SPECT-CT)) or positron emission tomography (PET-CT) for early RHID diagnosis [117,118].…”

Cardiovascular Care of the Oncology Patient During COVID-19: An Expert Consensus Document From the ACC Cardio-Oncology and Imaging Councils

“…Although the routine use of multigated radionuclide angiography in cardio-oncology is declining because of concerns of cumulative radiation exposure, it offers an alternative assessment of LVEF with minimal contact between patients and technicians (34). Cardiac computed tomography (CCT) has emerging clinical value in cardiooncology for pretreatment CVD risk assessment, evaluation of CVD or suspected toxicity during cancer treatment, and in survivors post treatment (35). CCT may function as an alternate to stress testing to assess coronary artery disease (CAD) in low-to intermediate-risk patients.…”