Reporting of coronary artery calcification on chest CT studies in breast cancer patients at high risk of cancer therapy related cardiac events

Phillips, William J.; Johnson, Christopher; Law, Angeline; Turek, Michèle; Small, Alex R.; Inácio, J.; Dent, Susan; Ruddy, Terrence D.; Chow, Benjamin J.W.; Small, Gary

doi:10.1016/j.ijcha.2018.02.001

Cited by 20 publications

(20 citation statements)

References 24 publications

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“…Our study also shows that there was significant underutilization of statins in AF patients and that reporting CAC in CTPV reports did not improve the statin therapy pattern. The reporting rate of CAC on CTPV in our study of 92.8% was higher than in prior studies showing the reporting of CAC to be 18.6%-69% on CT clinical reports [17][18][19]. This excellent reporting ratio can be explained by the fact that all CTPVs in this study were read by cardiologists who were trained in cardiac CT and aware of the clinical importance of CAC detection.…”

Section: Discussioncontrasting

confidence: 71%

“…While CAC is typically detected and quantified using a dedicated non-contrast CT CAC scan with electrocardiogram(ECG)-gating, CAC detected using contrast-enhanced cardiac CT correlates strongly with dedicated CAC scans [12][13][14][15]. Evaluating and reporting CAC on all non-contrast chest CT scans is recommended, though it is not commonly reported [16][17][18][19]. CAC was incorporated into the 2013 guidelines as one of the few other tests that function as a risk modifier in subjects at intermediate risk and was explicitly incorporated into the CV risk prediction guidelines in 2018 [20,21].…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Coronary Artery Calcification on Pre-Atrial Fibrillation Ablation CT Pulmonary Venograms and its Impact on Selection for Statin Therapy

Dunleavy

Guha

Cardona

et al. 2020

JCM

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Atherosclerotic cardiovascular disease (ASCVD) shares many risk factors with atrial fibrillation (AF). Obtaining computed tomography images of the pulmonary veins (CTPV) before AF ablation procedures is common and can incidentally detect coronary artery calcification (CAC). The purpose of this study was to investigate the prevalence of CAC on pre-ablation CTPV, the frequency of CAC reporting on CTPV reports, and its impact on statin therapy among patients hospitalized for AF procedures. We retrospectively evaluated consecutive patients undergoing CTPV and AF procedures from October 2016 to December 2017 in a single-center tertiary hospital. The patients’ demographic and clinical characteristics were analyzed. The CAC presence on CTPV was visually assessed. The severity was classified qualitatively. The statin therapy status was evaluated using the patient’s admission and discharge medication lists. A total of 638 subjects were included in our study, with 34.5% female. The mean age was 63.3 ± 10.8 years. CAC was detected in 70.1% of all patients, and in 58.1% of patients without a history of ASCVD. When present, CAC was documented in 92.6% of the clinical CTPV reports. While coronary artery atherosclerosis was present in a majority of AF patients, and its presence was widely reported, it was not associated with increased statin therapy at discharge.

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Section: Discussioncontrasting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

Prevalence of Coronary Artery Calcification on Pre-Atrial Fibrillation Ablation CT Pulmonary Venograms and its Impact on Selection for Statin Therapy

Dunleavy

Guha

Cardona

et al. 2020

JCM

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“…It is found that CV disease and breast cancer have several overlapping risk factors, such as obesity and smoking, meanwhile cardiovascular events (CVEs) is considered as one of the major causes of death in breast cancer patients undergoing chemotherapy, and AIs may contribute to the development of CVEs [7, 50–52]. For older women, the CV disease may pose a greater mortality threat than breast cancer itself [7].…”

Section: Discussionmentioning

confidence: 99%

Aromatase inhibitors and risk of cardiovascular events in breast cancer patients: a systematic review and meta-analysis

Zhang²,

Shen

et al. 2019

BMC Pharmacol Toxicol

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BackgroundCardiovascular events (CVEs) was considered as one of the primary cause to reduce the quality of life in breast cancer patients with aromatase inhibitors (AIs) treatment, which has not been sufficiently addressed. The aim of this study was to assess the correlation between risk of CVEs and AIs in patients with breast cancer.MethodsIncluded studies were obtained from the databases of Embase, Pubmed, Cochrane Library, Clinical Trials.gov, and reference lists. The main outcome measures were overall incidence, odds ratios (ORs), and 95% confidence intervals (CIs). Furthermore, the association and the risk differences among different tumor types, AIs,ages,or treatment regimens were conducted. Fixed-effect or random-effect models were applied in the statistical analyses according to the heterogeneity. Our analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.ResultsSeventeen studies, which included 44,411 subjects, were included in our analyses. The overall incidence of CVEs in AIs group was 13.02% (95% CI: 8.15–20.17%) and almost all of the high-grade CVEs occurred in patients treated with AIs. The pooled ORs of CVEs was 0.9940 (95% CI: 0.8545–1.1562). Under sub-group analysis, the incidence of CVEs related to exemestane was higher than that of controls (OR = 1.1564, 95% CI: 1.0656–1.2549), but no statistical differences in risk of CVEs were found in other sub-group analysis. No evidence of publication bias was found for incidence of CVEs in our meta-analysis by a funnel plot.ConclusionsThese results suggest that patients with breast cancer treated with AIs do not have a significant risk of developing CVEs in comparison with the controls, and exemestane might not be considered as the alternative AI to the breast cancer patients from the perspective of CVEs. Further studies are recommended to investigate this association and the risk differences among different tumor types, AIs or treatment regimens.

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“…It is found that CV disease and breast cancer have several overlapping risk factors, such as obesity and smoking, meanwhile cardiovascular events (CVEs) is considered as one of the major causes of death in breast cancer patients undergoing chemotherapy, and AIs may contribute to the development of CVEs [7,[49][50][51]. For older women, the CV disease may pose a greater mortality threat than breast cancer itself [7].…”

Section: Discussionmentioning

confidence: 99%

Aromatase inhibitors and risk of cardiovascular events in breast cancer patients: A systematic review and meta-analysis

Zhang²,

Shen

et al. 2019

Preprint

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Objective Cardiovascular events (CVEs) was considered as one of the primary cause to reduce the quality of life in breast cancer patients with aromatase inhibitors (AIs) treatment, which has not been sufficiently addressed. The aim of this study was to assess the correlation between risk of CVEs and AIs in patients with breast cancer. Methods Included studies were obtained from the databases of Embase, Pubmed, Cochrane Library, Clinical Trials.gov, and reference lists. The main outcome measures were overall incidence, odds ratios (ORs), and 95% confidence intervals (CIs). Furthermore, the association and the risk differences among different tumor types, AIs, ages,or treatment regimens were conducted. Fixed-effect or random-effect models were applied in the statistical analyses according to the heterogeneity. Our analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results Seventeen studies, which included 44411 subjects, were included in our analyses.The overall incidence of CVEs in AIs group was 13.02% (95% CI: 8.15%–20.17%) and almost all of the high-grade CVEs occurred in patients treated with AIs. The pooled ORs of CVEs was 0.9940 (95% CI: 0.8545-1.1562). Under sub-group analysis, the incidence of CVEs related to exemestane was higher than that of controls (OR=1.1564, 95% CI: 1.0656-1.2549), but no statistical differences in risk of CVEs were found in other sub-group analysis. No evidence of publication bias was found for incidence of CVEs in our meta-analysis by a funnel plot. Conclusions These results suggest that patients with breast cancer treated with AIs do not have a significant risk of developing CVEs in comparison with the controls, and exemestane might not be considered as the alternative AI to the breast cancer patients from the perspective of CVEs. Further studies are recommended to investigate this association and the risk differences among different tumor types, AIs or treatment regimens.

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Reporting of coronary artery calcification on chest CT studies in breast cancer patients at high risk of cancer therapy related cardiac events

Cited by 20 publications

References 24 publications

Prevalence of Coronary Artery Calcification on Pre-Atrial Fibrillation Ablation CT Pulmonary Venograms and its Impact on Selection for Statin Therapy

Prevalence of Coronary Artery Calcification on Pre-Atrial Fibrillation Ablation CT Pulmonary Venograms and its Impact on Selection for Statin Therapy

Aromatase inhibitors and risk of cardiovascular events in breast cancer patients: a systematic review and meta-analysis

Aromatase inhibitors and risk of cardiovascular events in breast cancer patients: A systematic review and meta-analysis

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