PDF(Pubmed)
Abstract：
UNASSIGNED: Radiotherapy may cause grade ≥3 cardiac events, necessitating a better understanding of risk factors. The potential predictive role of imaging biomarkers with radiotherapy doses for cardiac event occurrence has not been studied.
UNASSIGNED: The aim of this study was to establish the associations between cardiac substructure dose and coronary artery calcium (CAC) scores and cardiac event occurrence.
UNASSIGNED: A retrospective cohort analysis included patients with locally advanced non-small cell lung cancer treated with radiotherapy (2006-2018). Cardiac substructures, including the left anterior descending coronary artery, left main coronary artery, left circumflex coronary artery, right coronary artery, and TotalLeft (left anterior descending, left main, and left circumflex coronary arteries), were contoured. Doses were measured in 2-Gy equivalent units, and visual CAC scoring was compared with automated scoring. Grade ≥3 adverse cardiac events were recorded. Time-dependent receiver-operating characteristic modeling, the log-rank statistic, and competing-risk models were used to measure prediction performance, threshold modeling, and the cumulative incidence of cardiac events, respectively.
UNASSIGNED: Of the 233 eligible patients, 61.4% were men, with a median age of 68.1 years (range: 34.9-90.7 years). The median follow-up period was 73.7 months (range: 1.6-153.9 months). Following radiotherapy, 22.3% experienced cardiac events, within a median time of 21.5 months (range: 1.7-118.9 months). Visual CAC scoring showed significant correlation with automated scoring (r = 0.72; P < 0.001). In a competing-risk multivariable model, TotalLeft volume receiving 15 Gy (per 1 cc; HR: 1.38; 95% CI: 1.11-1.72; P = 0.004) and CAC score >5 (HR: 2.51; 95% CI: 1.08-5.86; P = 0.033) were independently associated with cardiac events. A model incorporating age, TotalLeft CAC (score >5), and volume receiving 15 Gy demonstrated a higher incidence of cardiac events for a high-risk group (28.9%) compared with a low-risk group (6.9%) (P < 0.001).
UNASSIGNED: Adverse cardiac events associated with radiation occur in more than 20% of patients undergoing thoracic radiotherapy within a median time of <2 years. The present findings provide further evidence to support significant associations between TotalLeft radiotherapy dose and cardiac events and define CAC as a predictive risk factor.
UNASSIGNED: The aim of this study was to establish the associations between cardiac substructure dose and coronary artery calcium (CAC) scores and cardiac event occurrence.
UNASSIGNED: A retrospective cohort analysis included patients with locally advanced non-small cell lung cancer treated with radiotherapy (2006-2018). Cardiac substructures, including the left anterior descending coronary artery, left main coronary artery, left circumflex coronary artery, right coronary artery, and TotalLeft (left anterior descending, left main, and left circumflex coronary arteries), were contoured. Doses were measured in 2-Gy equivalent units, and visual CAC scoring was compared with automated scoring. Grade ≥3 adverse cardiac events were recorded. Time-dependent receiver-operating characteristic modeling, the log-rank statistic, and competing-risk models were used to measure prediction performance, threshold modeling, and the cumulative incidence of cardiac events, respectively.
UNASSIGNED: Of the 233 eligible patients, 61.4% were men, with a median age of 68.1 years (range: 34.9-90.7 years). The median follow-up period was 73.7 months (range: 1.6-153.9 months). Following radiotherapy, 22.3% experienced cardiac events, within a median time of 21.5 months (range: 1.7-118.9 months). Visual CAC scoring showed significant correlation with automated scoring (r = 0.72; P < 0.001). In a competing-risk multivariable model, TotalLeft volume receiving 15 Gy (per 1 cc; HR: 1.38; 95% CI: 1.11-1.72; P = 0.004) and CAC score >5 (HR: 2.51; 95% CI: 1.08-5.86; P = 0.033) were independently associated with cardiac events. A model incorporating age, TotalLeft CAC (score >5), and volume receiving 15 Gy demonstrated a higher incidence of cardiac events for a high-risk group (28.9%) compared with a low-risk group (6.9%) (P < 0.001).
UNASSIGNED: Adverse cardiac events associated with radiation occur in more than 20% of patients undergoing thoracic radiotherapy within a median time of <2 years. The present findings provide further evidence to support significant associations between TotalLeft radiotherapy dose and cardiac events and define CAC as a predictive risk factor.
摘要：
■放疗可引起≥3级心脏事件，需要更好地了解风险因素。影像学生物标志物与放疗剂量对心脏事件发生的潜在预测作用尚未研究。
■本研究的目的是建立心脏亚结构剂量和冠状动脉钙（CAC）评分与心脏事件发生之间的关联。
■回顾性队列分析包括接受放疗的局部晚期非小细胞肺癌患者（2006-2018）。心脏亚结构,包括左冠状动脉前降支,左冠状动脉主干,左回旋支冠状动脉,右冠状动脉,和TotalLeft（左前降支，左主干道,和左回旋冠状动脉)，轮廓。剂量以2-Gy当量单位测量，视觉CAC评分与自动评分进行比较。记录≥3级不良心脏事件。时间相关的接收机工作特性建模，对数秩统计量，竞争风险模型被用来衡量预测性能，阈值建模，以及心脏事件的累积发生率，分别。
■在233名符合条件的患者中，61.4%是男性，年龄中位数为68.1岁（范围：34.9-90.7岁）。中位随访期为73.7个月（范围：1.6-153.9个月）。放疗后，22.3%经历过心脏事件，中位时间为21.5个月（范围：1.7-118.9个月）。视觉CAC评分与自动评分有显著相关性(r=0.72;P<0.001)。在竞争风险多变量模型中，接受15Gy(每1cc;HR:1.38;95%CI:1.11-1.72;P=0.004)和CAC评分>5(HR:2.51;95%CI:1.08-5.86;P=0.033)与心脏事件独立相关。一个包含年龄的模型，TotalLeftCAC(得分>5),与低危组(6.9%)相比,高危组(28.9%)的心脏事件发生率更高(P<0.001).
■超过20%的接受胸部放疗的患者在中位时间<2年内发生与放疗相关的不良心脏事件。本研究结果提供了进一步的证据来支持TotalLeft放疗剂量与心脏事件之间的显著关联，并将CAC定义为预测风险因素。
■本研究的目的是建立心脏亚结构剂量和冠状动脉钙（CAC）评分与心脏事件发生之间的关联。
■回顾性队列分析包括接受放疗的局部晚期非小细胞肺癌患者（2006-2018）。心脏亚结构,包括左冠状动脉前降支,左冠状动脉主干,左回旋支冠状动脉,右冠状动脉,和TotalLeft（左前降支，左主干道,和左回旋冠状动脉)，轮廓。剂量以2-Gy当量单位测量，视觉CAC评分与自动评分进行比较。记录≥3级不良心脏事件。时间相关的接收机工作特性建模，对数秩统计量，竞争风险模型被用来衡量预测性能，阈值建模，以及心脏事件的累积发生率，分别。
■在233名符合条件的患者中，61.4%是男性，年龄中位数为68.1岁（范围：34.9-90.7岁）。中位随访期为73.7个月（范围：1.6-153.9个月）。放疗后，22.3%经历过心脏事件，中位时间为21.5个月（范围：1.7-118.9个月）。视觉CAC评分与自动评分有显著相关性(r=0.72;P<0.001)。在竞争风险多变量模型中，接受15Gy(每1cc;HR:1.38;95%CI:1.11-1.72;P=0.004)和CAC评分>5(HR:2.51;95%CI:1.08-5.86;P=0.033)与心脏事件独立相关。一个包含年龄的模型，TotalLeftCAC(得分>5),与低危组(6.9%)相比,高危组(28.9%)的心脏事件发生率更高(P<0.001).
■超过20%的接受胸部放疗的患者在中位时间<2年内发生与放疗相关的不良心脏事件。本研究结果提供了进一步的证据来支持TotalLeft放疗剂量与心脏事件之间的显著关联，并将CAC定义为预测风险因素。
