Computed tomography-derived myocardial extracellular volume: an early biomarker of cardiotoxicity in esophageal cancer patients undergoing radiation therapy

Abstract

Objectives We aimed to assess extracellular volume (ECV) through non-gated, contrast-enhanced computed tomography (CT) before and after radiation therapy (RT) in patients with esophageal cancer (EC). Materials and methods EC patients who had undergone CT before and after RT were retrospectively assessed. Patients with preexisting cardiovascular disease or with heavily artifacted CT were excluded. ECV was calculated using density values for the myocardial septum and blood pool. Data were reported as mean and standard deviation or median and interquartile range according to their distribution; t test or Wilcoxon and Pearson r or Spearman ρ were subsequently used. Results Twenty-one patients with stage ≥ IB EC, aged 64 ± 18 years, were included. Mean and maximum RT doses were 21.2 Gy (16.9–24.1) and 42.5 Gy (41.8–49.2), respectively. At baseline (n = 21), hematocrit was 39% ± 4%, ECV 27.9% ± 3.5%; 35 days (30–38) after RT (n = 20), hematocrit was 36% ± 4%, lower than at baseline (p = 0.002), ECV 30.3% ± 8.3%, higher than at baseline (p = 0.081); at follow-up 420 days (244–624) after RT (n = 13), hematocrit was 36% ± 5%, lower than at baseline (p = 0.030), ECV 31.4% ± 4.5%, higher than at baseline (p = 0.011). No patients showed signs of overt cardiotoxicity. ECV early after RT was moderately positively correlated with maximum RT dose (ρ = 0.50, p = 0.036). Conclusions In EC patients, CT-derived myocardial ECV was increased after RT and may thus appear as a potential early biomarker of cardiotoxicity.

Extracellular volume measured by whole body CT scans predicts chronic cardiotoxicity in breast cancer patients treated with neoadjuvant therapies based on anthracyclines: A retrospective study

“…Although our data on non-CTRCD patients are consistent with those reported in the literature, to our knowledge we are the first to show data in CTRCD patients, reporting at baseline a range of mECV values (PP = 26.9–30 % and DP = 26–28.7 %) similar to previous observations [ 24 , 35 , 36 ]. Although our patients are younger (median 45 ± 4 years) than those described in other studies reported so far [ 24 , 26 , 36 ], the role of AD in reducing cardiac contractility and increasing the risk of CTRCD was already described [ 10 , 13 , 37 , 38 ].…”

“…Although our data on non-CTRCD patients are consistent with those reported in the literature, to our knowledge we are the first to show data in CTRCD patients, reporting at baseline a range of mECV values (PP = 26.9–30 % and DP = 26–28.7 %) similar to previous observations [ 24 , 35 , 36 ]. Although our patients are younger (median 45 ± 4 years) than those described in other studies reported so far [ 24 , 26 , 36 ], the role of AD in reducing cardiac contractility and increasing the risk of CTRCD was already described [ 10 , 13 , 37 , 38 ]. In a similar study on patients treated with AC, a cumulative cardiotoxicity incidence of 1.2 % per year was observed in patients younger than 55 years, reaching a 10.6 % risk in patients over-75 years [ 39 ], thus suggesting a synergy between drug cardiotoxicities and AD.…”

Myocardial extracellular volume derived from contrast-enhanced chest computed tomography in longitudinal evaluation of cardiac toxicity in patients treated with immune checkpoint inhibitors

“…Lastly, it is critical to note that the ECV in our study was measured using thoracic contrast-enhanced CT, including cardiac images, rather than specific cardiac CT. However, a study has confirmed the possibility of contrast-enhanced CT in measuring left ventricular ECV ( 29 ). In our study, images were acquired from portal phase, and the principle of images acquisition from portal phase has been addressed in various articles ( 16 ).…”

MRI-derived extracellular volume as a biomarker of cancer therapy cardiotoxicity: systematic review and meta-analysis

“…CT-derived ECV has shown strong correlations to MRI-derived ECV [47]; thus, findings related to the role of ECV in monitoring cancer therapy-related cardiotoxicity may potentially translate from MRI to CT, and the two modalities could also be used interchangeably according to clinical needs. For instance, previous studies have shown that myocardial ECV, assessed at non-gated contrast-enhanced CT, rises significantly in breast cancer patients undergoing anthracycline-based regimens [48] and in patients with esophagus cancer treated with chest radiotherapy [49]. In this sense, while it might not be realistic to screen each patient undergoing cancer treatment for cardiotoxicity using MRI, MRI could be reserved to high-risk patients, such as those with previous comorbidities, undergoing therapies such as anthracyclines or radiation therapy, which are known to yield a dose-dependent effect [50].…”