Incidental coronary calcium in cancer patients treated with anthracycline and/or trastuzumab

Abstract

Background Cancer patients are at increased risk of cardiovascular disease (CVD) after treatment with potentially cardiotoxic treatments. Many cancer patients undergo non-gated chest CT (NCCT) for cancer staging prior to treatment. Aims We aimed to assess whether coronary artery calcification (CAC) on NCCT predicts CVD risk in cancer patients. Methods 603 patients (mean age: 61.3 years, 30.8% male) with either breast cancer, lymphoma or sarcoma were identified retrospectively. Primary endpoint was a MACE composite including non-fatal myocardial infarction (MI), new heart failure (HF) diagnosis, HF hospitalization and cardiac death, with Fine-Gray analysis for non-cardiac death as competing risk. Secondary endpoints included a coronary composite and a HF composite. Results CAC was present in 194 (32.2%) and clinically reported in 85 (43.8%) patients. At a median follow-up of 5.3 years, 256 (42.5%) patients died of non-cardiac causes. CAC presence or extent was not an independent predictor of MACE (SHR 1.28; 0.73-2.27). CAC extent was a significant predictor of the coronary composite outcome (SHR per 2-fold increase 1.14; 1.01-1.28), but not of the HF composite outcome (SHR per 2-fold increase 1.04; 0.95-1.14). Conclusion CAC detected incidentally on NCCT scans in cancer patients is prevalent and often not reported. CAC presence or extent did not independently predict MACE. CAC extent was independently associated with increased risk of CAD events but not HF events.

New Insights in the Era of Clinical Biomarkers as Potential Predictors of Systemic Therapy-Induced Cardiotoxicity in Women with Breast Cancer: A Systematic Review

“…In addition to above-mentioned biomarkers, other potentially promising biomarkers are currently under investigation for their utility in the detection and/or prediction of CTRCD including: coronary artery calcification [ 298 ], endothelin-1 [ 299 ], neuregulin-1 [ 285 , 300 ], plasma bioactive adrenomedullin (ADM) [ 301 ], fragmented QRS (fQRS) [ 302 ], D-dimer [ 303 ], soluble fms-like tyrosine kinase receptor (sFlt)-1 [ 105 ], soluble ST2 (sST2) [ 145 , 149 , 171 , 279 , 304 ], CK-MB [ 134 , 286 ], topoisomerase II α gene ( TOP2A ) [ 305 ], cardiac myosin light chain 1 (cMLC-1) [ 306 ], vascular endothelial growth factor (VEGF) [ 93 ], placental growth factor (PIGF) [ 93 , 98 ], procollagen-derived type-I C-terminal-propeptide (PICP) [ 307 ], epicardial adipose tissue (EAT) volume [ 308 , 309 ], circulating bilirubin [ 310 ], hemopexin [ 311 ], glycated hemoglobin (HbA(1)c) [ 103 ], advanced oxidation protein products (AOPP) [ 102 ], human resistin [ 312 ] and vascular adhesion molecule 1 (VCAM-1) [ 117 ].…”

“…In addition, several studies in this review included metastatic breast cancer patients amongst their target population and investigated the potential of emerging biomarkers in the detection of CTRCD in these patients [ 128 , 130 , 183 , 222 , 255 , 298 , 304 , 329 ]. Noticeably, some of these studies, have highlighted the differential expression of specific biomarkers (e.g., sFas, sFasL, NT-proBNP) in metastatic breast cancer patients compared to non-metastatic [ 104 , 128 ].…”

Prognostic value of coronary atherosclerosis and CAC score for the risk of chemotherapy-related cardiac dysfunction (CTRCD): The protocol of ANTEC study

“…In 24% of patients CAC score was above zero and one in three patients with high CAC score had no other CVD risk factors [ 27 ]. A retrospective study by Hooks et al has shown that CAC extent was a significant predictor of the coronary composite outcome, but not of the heart failure composite outcome [ 28 ]. On the other hand, in a multi-center cohort of 66,636 asymptomatic adults without cardiovascular disease (CVD), high CAC predicted the risk of death from CVD in official death certificates, independently of CVD risk factors [ 29 ].…”

Cardiovascular disease and lung cancer

“…Patients with lung cancer undergo non-gated chest CT scans for cancer staging and surveillance. Incidental detection of coronary artery calcification is prevalent and can be helpful in providing CAD risk stratification and guiding prevention strategies ( 83 ). BP measurements that are routinely performed at oncology visits should be assessed and followed for the screening and monitoring of hypertension ( 84 ).…”