背景:尚不清楚冠状动脉CT血管造影(CCTA)是否可以检测癌症治疗相关的冠状动脉损伤并预测接受化疗(CHT)或放化疗(CRT)的肺癌患者的主要不良心血管事件(MACE)。
目的:本研究旨在使用CCTA参数评估接受CHT或CRT的肺癌患者的冠状动脉,并探讨这些参数与MACEs的关系。
方法:本研究回顾性收集了2013年6月至2019年5月在治疗前或治疗后2周内接受CHT或CRT并接受CCTA检查的697例肺癌患者的数据。将患者分为CHT组和CRT组,对于对照组,我们采用了倾向评分匹配(PSM),纳入了125例接受单一CCTA检查的无癌参与者.CCTA参数,使用人工智能软件评估,在不同的组中进行了比较(对照组与CHT&CRT;CHTvs.CRT)。我们使用Cox回归模型和Kaplan-Meier曲线分析了CCTA参数和MACE之间的关联,以比较无MACE生存率。
结果:在CHT或CRT之前,与对照组相比,在CHT和CRT组中,我们观察到较高的脂肪衰减指数(FAI),冠状动脉钙(CAC)评分,CAD-RADS分类,狭窄严重程度和较低的计算机断层扫描血流储备分数(CT-FFR;所有P<0.05)。治疗后,CT-FFR降低,FAI升高;同时,与CHT组相比,CRT组的CT-FFR较低,FAI较高(均P<0.05)。在146例发生MACE的病例中,与无MACE组相比,CT-FFR值较低,FAI值较高(均P<0.05),治疗前CT-FFR和FAI与MACEs相关。
结论:使用CT-FFR和FAI可以确定癌症治疗相关的冠状动脉损伤。治疗前,这些参数与接受CHT或CRT的肺癌患者的MACE相关.
BACKGROUND: Whether coronary computed-tomography angiography (CCTA) can detect cancer treatment-related impairments of coronary artery and predict major adverse cardiovascular events (MACEs) in lung cancer patients receiving chemotherapy (CHT) or chemoradiotherapy (CRT) is unclear.
OBJECTIVE: This study aimed to evaluate coronary arteries using CCTA parameters and explore the association of these parameters with MACEs in patients with lung cancer receiving CHT or CRT.
METHODS: This study retrospectively collected data from 697 lung cancer patients who received CHT or CRT and underwent CCTA examination within 2 weeks before or after treatment from June 2013 to May 2019. The patients were divided into CHT and CRT group, and for the control group, the propensity score matching (PSM) was used and 125 participants without carcinoma with a single CCTA examination were included. CCTA parameters, assessed using artificial intelligence software, were compared across different groups (control vs. CHT & CRT; CHT vs. CRT). We analyzed associations between CCTA parameters and MACEs using a Cox-regression model and Kaplan-Meier curves to compare MACE-free survival rates.
RESULTS: Before CHT or CRT, compared with the control group, in CHT&CRT group we observed higher fat attenuation index (FAI), coronary-artery calcium (CAC) score, CAD-RADS classification, stenosis severity and lower computed-tomography fractional flow reserve (CT-FFR; all P<0.05). After treatment, the CT-FFR decreased and the FAI increased; simultaneously, we observed a lower CT-FFR and higher FAI (all P<0.05) in the CRT than in the CHT group. Among the 146 cases developed MACEs, lower CT-FFR and higher FAI values were found compared with the non-MACE group (all P<0.05), and CT-FFR and FAI before treatment were associated with MACEs.
CONCLUSIONS: Cancer treatment-related impairments of coronary arteries could be identified using CT-FFR and FAI. Before treatment, these parameters were associated with MACEs in lung cancer patients receiving CHT or CRT.