Potential role of epicardial adipose tissue as a biomarker of anthracycline cardiotoxicity

Abstract

Background We investigated the radiodensity of epicardial (EAT), subcutaneous (SAT), and visceral adipose tissue (VAT) before and after treatment with anthracyclines in a population of breast cancer (BC) patients, and in controls not treated with anthracyclines, to detect a potential role of EAT density as a biomarker of changes related to chemotherapy cardiotoxicity. Methods We reviewed BC patients treated with anthracyclines who underwent CT before (CT-t0) and after (CT-t1) chemotherapy, and age- and sex-matched controls who underwent two CT examinations at comparable intervals. On non-contrast scans, EAT was segmented contouring the pericardium and thresholding between -190 and -30 Hounsfield units (HU), and SAT and VAT were segmented with two 15-mm diameter regions of interest thresholded between -195 and -45 HU. Results Thirty-two female patients and 32 controls were included. There were no differences in age (p = 0.439) and follow-up duration (p = 0.162) between patients and controls. Between CT-t0 and CT-t1, EAT density decreased in BC patients (-66 HU, interquartile range [IQR] -71 to -63 HU, to -71 HU, IQR -75 to -66 HU, p = 0.003), while it did not vary in controls (p = 0.955). SAT density increased from CT-t0 to CT-t1 in BC patients (-107 HU, IQR -111 to -105 HU, to -105 HU, IQR -110 to -100 HU, p = 0.014), whereas it did not change in controls (p = 0.477). VAT density did not vary in either BC patients (p = 0.911) or controls (p = 0.627). Conclusions EAT density appears to be influenced by anthracycline treatment for BC, well known for its cardiotoxicity, shifting towards lower values indicative of a less active metabolism.

Perivascular Adipose Tissue Density and Stenosis Plaque Degree in Lower Limb Peripheral Arteries in CT

“…Indeed, the visceral adipose tissue impacts vascular homeostasis by releasing factors that influence the layers of the smooth muscle cells, thereby regulating the vascular tone, blood flow distribution, angiogenesis, and inflammatory processes [7]. In fact, as already reported in the literature [8], there is a positive correlation between the perivascular attenuation levels of the perivascular adipose tissue (PVAT) measured in the CTA and the adjacent plaque, supporting a direct bilateral influence [6,[9][10][11][12][13][14][15][16].…”

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 ].…”

CT Images in Follicular Lymphoma: Changes after Treatment Are Predictive of Cardiac Toxicity in Patients Treated with Anthracycline-Based or R-B Regimens

“…Our study stems from the hypothesis that early identification and application of radiological patterns can detect anthracycline-induced cardiological damage early and identify patients with occult cardiological disease onset who would benefit from anthracycline-free treatment. Studies which have investigated this topic and have used MRI or CT for the extrapolation of early markers of anthracycline-induced cardiac damage such as ECV and EAT are few in the literature and mainly concern oncology in the context of breast cancer [16,18,[38][39][40][41][42].…”

“…Cardiac anomalies can occur years after therapy and may be more frequent in the presence of risk factors such as advanced age, male gender, overweight and, above all, the cumulative dose of AC [14]. Anthracyclines have long been linked with the dose-related development of fibrosis [15,16]. Clinically, the effects may be heterogeneous and in the long term may lead to left ventricular ejection fraction (LVEF) depression or symptomatic heart failure [15,17,18].…”