背景:乳腺癌(BC)的新辅助化疗是有效的,但有潜在的心脏毒性,并将长期存活者暴露在化疗相关心脏功能障碍(CTRCD)的风险中。不幸的是,CTRCD的早期筛查具有实际诊断限制.心肌细胞外容积(mECV)是心脏CT扫描和心脏磁共振中用于CTRCD诊断和随访的放射学标志物。它可以在全身CT(WB-CT)扫描中测量,在复发风险高的患者中常规进行,评估肿瘤随访期间CTRCD的发生。
方法:82在基线(T0)和新辅助治疗结束后第一年(T1)和第五年(T5)的肿瘤随访期间检查WB-CT扫描。在造影剂注射后1分钟(PP)和5分钟(DP)测量mECV。在T1检索了31张超声心动图,以在mECV和左心室射血分数(LVEF)之间进行线性相关。
结果:两组在PP和DP中T0的mECV值相似。发现T1中PP值的显着结果(37.0%vs32%,p=0.0005)和T5(27.2%对31.2%,p=0.025)。PP中35%的截断值在T1中被证明是显著的(OR=12.4,p=0.004),在PP(adj-S=-3.54,adj-p=0.002)和DP(adj-S=-2.51,adj-p=0.0002)中,mECV与LVEF呈负相关,提示与诊断时年龄的协同作用(分别为p<0.0001)。
结论:复发高危患者在肿瘤重新评估期间进行的WB-CT扫描可用于心血管低危患者的CTRCD筛查。尤其是mECV值在35%以上的老年患者。
BACKGROUND: Neoadjuvant chemotherapies for breast cancer (BC) are effective but potentially cardiotoxic, and expose long survivors at risk of chemotherapy-related cardiac dysfunction (
CTRCD). Unfortunately, early screening for
CTRCD has actual diagnostic limits. Myocardial extracellular volume (mECV) is a radiological marker used in cardiac CT scans and cardiac magnetic resonance for diagnosis and follow-up of
CTRCD. It can be measured in whole-body CT (WB-CT) scan, routinely performed in patients at high risk of relapse, to evaluate
CTRCD occurrence during oncological follow-up.
METHODS: 82 WB-CT scans were examined at baseline (T0) and during oncological follow-up at first year (T1) and fifth year (T5) after the end of neoadjuvant treatment. mECV was measured at 1 min (PP) and 5 min (DP) after contrast injection. 31 echocardiograms were retrieved in T1 to perform a linear correlation between mECV and left ventricular ejection fraction (LVEF).
RESULTS: mECV values in T0 were similar between the two groups both in PP and in DP. Significant results were found for PP values in T1 (37.0 % vs 32 %, p = 0.0005) and in T5 (27.2 % vs 31.2 %, p = 0.025). A cut-off value of 35 % in PP proved significant in T1 (OR = 12.4, p = 0.004), while mECV was inversely correlated with LVEF both in PP (adj-S = -3.54, adj-p = 0.002) and in DP (adj-S = -2.51, adj-p = 0.0002), suggesting a synergistic action with the age at diagnosis (p < 0.0001, respectively).
CONCLUSIONS: WB-CT scans performed during oncological reassessment in patients at high-risk of recurrence could be used for
CTRCD screening in cardiovascular low-risk patients, especially in aging patients with mECV values above 35 %.