Cardiac computed tomography-derived extracellular volume fraction in the identification of cardiotoxicity: Another emerging imaging option

Schindler, Thomas; Sharma, Vijay; Bhandiwad, Anita

doi:10.1016/j.ijcha.2021.100806

Cited by 4 publications

(5 citation statements)

References 14 publications

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“…This marker was already proven to be effective in the particular context of cardiac MRI and CT scans [ 7 , 13 , 16 ] in the acute and chronic CTX settings; in our case, however, the cost-effectiveness and routinary use of WB-CT in an oncological clinical setting is the major strength point of this study. Furthermore, it is the first study with a long-lasting FU with a timepoint assessed at five years from chemotherapy termination, whereas the other authors reported last evaluations at the latest within the first 2 years [ 13 , 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

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Quantification of Extracellular Volume in CT in Neoadjuvant Chemotherapy in Breast Cancer: New Frontiers in Assessing the Cardiotoxicity of Anthracyclines and Trastuzumab

Chiocchi

Cerocchi

Tosto³

et al. 2023

JPM

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Breast cancer patients undergoing neoadjuvant chemotherapy with anthracyclines or trastuzumab can suffer cardiotoxic issues. Nowadays, the markers of cardiac damage are still not reliable, and extracellular volume (ECV) calculated from CT could be a promising cardiotoxic marker. Eighty-two patients, treated with two different chemotherapy regimens based on doxorubicin (DOX) or epirubicin-trastuzumab (EPI–TRAS), were retrospectively selected and the variations in extracellular volume (ECV) values were measured and analyzed. Whole Body CT (WB-CT) scans were acquired after 1 min, in the portal phase (PP), and after 5 min, in the delayed phases (DP), at the baseline (T0), after one year (T1) and after five years (T5) from the end of chemotherapies. The values measured by two radiologists with different levels of experience were evaluated in order to assess the inter-reader reproducibility assessment (ICC = 0.52 for PP and DP). Further, we performed a population-based analysis and a drug-oriented subgroup analysis in 54 DOX-treated and 28 EPI–TRAS-treated patients. In the general cohort of women treated with any of the two drugs, we observed in the lapse T0–T1 a relative increase (RI) of 25% vs. 20% (PP vs. DP, p < 0.001) as well as in the lapse T0–T5 an RI of 17% vs. 15% (PP vs. DP, p < 0.01). The DOX-treated patients reported in the lapse T0–T1 an RI of 22% (p < 0.0001) in PP and an RI of 16% (p = 0.018) in the DP, with ECV values remaining stably high at T5 both in PP (RI 14.0%, p < 0.0001) and in DP (RI 17%, p = 0.005) highlighting a possible hallmark of a persisting CTX sub-damage. On the other hand, ECV measured in EPI–TRAS-treated women showed an RI in T0–T1 of 18% (p = 0.001) and 29% (p = 0.006) in PP and DP, respectively, but the values returned to basal levels in T5 both in the PP (p = 0.12) and in DP setting (p = 0.13), suggesting damage in the first-year post-treatment and a possible recovery over time. For the 82 patients, an echocardiography was performed at T0, T1= 12 m + 3 m and T5 = 60 m + 6 m with LVEF values at T0 (64% ± 5%), T1 (54% ± 6%) and T5 (53% ± 8%). WB-CT-derived ECV values could provide a valid imaging marker for the early diagnosis of cardiotoxic damage in BC patients undergoing oncological treatments. We detected different patterns during the follow-up, with stably high values for DOX, whereas EPI–TRAS showed a peak within the first year, suggesting different mechanisms of cardiac damage.

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Section: Discussionmentioning

confidence: 99%

“…Therefore, to overcome these limitations, the calculation of ECV by computed tomography (CT) has been recently proposed [ 21 ]. CT-derived ECV has proven to have a high correlation with both MRI-derived ECV and histological findings [ 13 , 21 , 22 , 23 , 24 ].…”

Section: Introductionmentioning

confidence: 99%

Quantification of Extracellular Volume in CT in Neoadjuvant Chemotherapy in Breast Cancer: New Frontiers in Assessing the Cardiotoxicity of Anthracyclines and Trastuzumab

Chiocchi

Cerocchi

Tosto³

et al. 2023

JPM

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“…Given the above background, we recently reported a similarity between CCT and CMR in cancer therapy‐related cardiac dysfunction (CTRCD) cases in terms of consistency between the ECV maps from CCT and CMR and between late iodine enhancement in CCT and late gadolinium enhancement (LGE) in CMR 6,7 . Moreover, regarding late cardiac function in patients after using anthracycline treatment, we demonstrated that CCT may be comparable with echocardiography because the ECV determined by CCT behaved the same as left ventricular (LV) ejection fraction (EF) (end‐diastolic volume and end‐systolic volume) and LV‐global longitudinal strain (GLS) as determined by echocardiography 8 ; the clinical application of CCT in the cardiooncology area is expected in the coming years 9,10 …”

Section: Introductionmentioning

confidence: 90%

“…6,7 Moreover, regarding late cardiac function in patients after using anthracycline treatment, we demonstrated that CCT may be comparable with echocardiography because the ECV determined by CCT behaved the same as left ventricular (LV) ejection fraction (EF) (end-diastolic volume and end-systolic volume) and LV-global longitudinal strain (GLS) as determined by echocardiography 8 ; the clinical application of CCT in the cardiooncology area is expected in the coming years. 9,10 In the present study, to enhance the clinical usefulness of CCT in cardiooncology, we investigated serial changes in the CCT-derived ECV fraction in anthracycline-treated breast cancer patients.…”

Section: Introductionmentioning

confidence: 99%

Cardiac computed tomography‐derived myocardial tissue characterization after anthracycline treatment

et al. 2022

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Aims Understanding cardiac function after anthracycline administration is very important from the perspective of preventing the onset of heart failure. Although cardiac magnetic resonance and echocardiography are recognized as the ‘gold standard’ for detecting cardiotoxicity, they have many shortcomings. We aimed to investigate whether cardiac computed tomography (CCT) could replace these techniques, assessing serial changes in cardiac tissue characteristics as determined by CCT after anthracycline administration. Methods and results We prospectively investigated 15 consecutive breast cancer patients who were scheduled to receive anthracycline therapy. We performed echocardiography and CCT before and 3, 6, and 12 months after anthracycline treatment. The mean cumulative administered anthracycline dose was 269.9 ± 14.6 mg/m2 (doxorubicin‐converted dose). Of the 15 enrolled patients who received anthracycline treatment for breast cancer, none met the definition of cardiotoxicity. The CCT‐derived extracellular volume fraction tended to continue to increase after anthracycline treatment and had relatively similar dynamics to the left ventricular ejection fraction and global longitudinal strain as determined by echocardiography. Conclusions Our findings indicated that CCT could provide adequate information about the characteristics of myocardial tissue after anthracycline administration. CCT may improve the understanding of cardiotoxicity by compensating for the weaknesses of echocardiography. This technique could be useful for understanding cardiac tissue characterization as a ‘one‐stop shop’ evaluation, providing new insight into cardiooncology.

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“…CT for the measurement of ECV appears to be as reliable as magnetic resonance imaging (MRI), the latter being more difficult to access, both because it is not routinely performed in the evaluation of disease in patients with FL and it has a high cost of implementation or execution [22][23][24][25].…”

Section: Introductionmentioning

confidence: 99%

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

Esposito,

Mezzanotte,

Tesei

et al. 2024

Cancers

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The aim of this study is to evaluate changes in epicardial adipose tissue (EAT) and cardiac extracellular volume (ECV) in patients with follicular lymphoma (FL) treated with R-CHOP-like regimens or R-bendamustine. We included 80 patients with FL between the ages of 60 and 80 and, using computed tomography (CT) performed at onset and at the end of treatment, we assessed changes in EAT by measuring tissue density at the level of the cardiac apex, anterior interventricular sulcus and posterior interventricular sulcus of the heart. EAT is known to be associated with metabolic syndrome, increased calcium in the coronary arteries and therefore increased risk of coronary artery disease. We also evaluated changes in ECV, which can be used as an early imaging marker of cardiac fibrosis and thus myocardial damage. The R-CHOP-like regimen was associated with lower EAT values (p < 0.001), indicative of a less active metabolism and more adipose tissue, and an increase in ECV (p < 0.001). Furthermore, in patients treated with anthracyclines and steroids (R-CHOP-like) there is a greater decrease in ejection fraction (EF p < 0.001) than in the R-B group. EAT and ECV may represent early biomarkers of cardiological damage, and this may be considered, to our knowledge, the first study investigating radiological and cardiological parameters in patients with FL.

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Cardiac computed tomography-derived extracellular volume fraction in the identification of cardiotoxicity: Another emerging imaging option

Cited by 4 publications

References 14 publications

Quantification of Extracellular Volume in CT in Neoadjuvant Chemotherapy in Breast Cancer: New Frontiers in Assessing the Cardiotoxicity of Anthracyclines and Trastuzumab

Quantification of Extracellular Volume in CT in Neoadjuvant Chemotherapy in Breast Cancer: New Frontiers in Assessing the Cardiotoxicity of Anthracyclines and Trastuzumab

Cardiac computed tomography‐derived myocardial tissue characterization after anthracycline treatment

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

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