Pretreatment chest CT may predict cardiotoxic events from large B-cell lymphoma treatment
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Automatic calcium scoring with nongated chest CT was prognostic of major adverse and cardiotoxicity-related CV events in patients with large B-cell lymphoma undergoing anthracycline-based chemotherapy, researchers reported.
“Balancing the cardiovascular risk and survival benefit of anthracycline-based chemotherapy in patients with diffuse large B-cell lymphoma is an important clinical issue,” Hesong Shen, MD, of the department of radiology at Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, China, and colleagues wrote. “The coronary artery calcium score is a risk indicator for cardiovascular disease. Whether the coronary artery calcium score can be used for the risk stratification of cancer therapy-related cardiac dysfunction and major adverse cardiovascular events prior to treatment in patients with diffuse large B-cell lymphoma who receive anthracycline-based chemotherapy is unclear.”
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For this analysis, Shen and colleagues retrospectively enrolled 1,468 patients (683 women; 100% Asian) with diffuse large B-cell lymphoma at four hospitals who underwent nongated chest CT before treatment. The CAC score was calculated using artificial intelligence-based automatic calcium scoring software and participants were classified into one of three categories of coronary calcium by Agatston units: 0, 1 to 100 and more than 100.
The findings were published in Circulation: Cardiovascular Imaging.
Estimating CV risk from cancer treatment
During a median follow-up time of 69 months, 24.66% of patients developed cancer therapy-related cardiac dysfunction and 12.6% experienced a major adverse CV event.
Compared with patients with a CAC score of 0 at baseline on automatic AI calcium scoring, likelihood of cancer therapy-related cardiac dysfunction was increased among patients with a CAC score of 1 to 100 (OR = 2.587; 95% CI, 2.203-5.168; P < .001) and a score of more than 100 (OR = 5.239; 95% CI, 3.308-8.984; P < .001).
Compared with patients with a CAC score of 0 at baseline on automatic AI calcium scoring, risk for major adverse CV events was increased among patients with a CAC score of 1 to 100 (HR = 3.726; 95% CI, 2.315-5.995; P < .001) and a score of more than 100 (HR = 7.858; 95% CI, 4.899-12.606; P < .001).
“In this study, the automatic coronary artery calcium score derived from chest computed tomography before treatment was associated with cancer therapy-related cardiac dysfunction and major adverse cardio-vascular events in patients with diffuse large B-cell lymphoma who received anthracycline-based chemotherapy,” the researchers wrote. “The automatic coronary artery calcium score could be helpful in the personalized management of patients at high risk of cancer therapy-related cardiac dysfunction and major adverse cardiovascular events.”
Utility of chest CT in pretreatment risk prediction
In a related editorial, Julia Karady, MD, and Maros Ferencik, MD, PhD, MCR, instructors in radiology at the Cardiovascular Imaging Research Center at Harvard Medical School, Massachusetts General Hospital, discussed the implications of these findings in clinical practice.
“The results reported by Shen et al ... corroborate prior evidence that CAC measured on pretreatment nongated chest CT can be utilized for risk estimation of not only major adverse CV events but also cancer therapy-related cardiac dysfunction. They suggest that chest CTs, constituting a part of routine clinical workup of patients with cancer, carry important prognostic information, especially for those patients without any prior history of atherosclerotic CVD,” Karady and Ferencik wrote. “Cardiovascular diseases and most cancer types, apart from few exceptions, develop around the same age and are associated due to their shared risk factors, therefore, conclusions of this study underline the notion of considering patients with cancer in a more holistic approach.”
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