Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea.
Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea.
Breast Cancer Res Treat. 2022 Nov;196(1):111-119. doi: 10.1007/s10549-022-06696-z. Epub 2022 Aug 31.
Chemotherapy-induced cardiotoxicity is a critical issue for patients with breast cancer. Change of epicardial adipose tissue (EAT) is associated with cardiac dysfunction. The objective of this study was to investigate the relationship between EAT and chemotherapy-induced cardiotoxicity.
This retrospective study analyzed EAT on chest computed tomography (CT) of patients with early breast cancer using automatic, quantitative measurement software between November 2015 and January 2020. Changes in EAT before and after initiation of chemotherapy were compared according to the type of anticancer drug. Subclinical cardiotoxicity was defined as worsening ≥ 10% in left ventricular ejection fraction to an absolute value > 50% with a lower limit of normal measured with standard echocardiography.
Among 234 patients with breast cancer, 85 were treated with adjuvant anthracycline-based (AC) and 149 were treated with non-anthracycline-based (non-AC) chemotherapy. There was a significant increase in EAT volume index (mL/kg/m) at the end of chemotherapy compared to that at the baseline in the AC group (3.33 ± 1.53 vs. 2.90 ± 1.52, p < 0.001), but not in the non-AC group. During the follow-up period, subclinical cardiotoxicity developed in 20/234 (8.6%) patients in the total population [13/85 (15.3%) in the AC group and 7/149 (4.8%) in the non-AC group]. In the multivariable analysis, EAT volume index increment after chemotherapy was associated with a lower risk of subclinical cardiotoxicity in the AC group (Odds ratio: 0.364, 95% CI 0.136-0.971, p = 0.044).
Measurement of EAT during anthracycline-based chemotherapy might help identify subgroups who are vulnerable to chemotherapy-induced cardiotoxicity. Early detection of EAT volume change could enable tailored chemotherapy with cardiotoxicity prevention strategies.
化疗引起的心脏毒性是乳腺癌患者的一个关键问题。心外膜脂肪组织（EAT）的变化与心脏功能障碍有关。本研究的目的是探讨 EAT 与化疗引起的心脏毒性之间的关系。
本回顾性研究使用自动、定量测量软件，于 2015 年 11 月至 2020 年 1 月，对早期乳腺癌患者的胸部 CT 进行 EAT 分析。根据抗癌药物的类型，比较化疗前和化疗后 EAT 的变化。亚临床心脏毒性定义为左心室射血分数恶化≥10%，绝对值>50%，使用标准超声心动图测量正常值下限。
在 234 例乳腺癌患者中，85 例接受辅助蒽环类药物（AC）化疗，149 例接受非蒽环类药物（非-AC）化疗。AC 组化疗结束时的 EAT 体积指数（mL/kg/m）与基线相比显著增加（3.33±1.53 比 2.90±1.52，p<0.001），而非-AC 组则没有。在随访期间，总人群中有 20/234（8.6%）例患者出现亚临床心脏毒性[AC 组 13/85（15.3%）例和非-AC 组 7/149（4.8%）例]。多变量分析显示，化疗后 EAT 体积指数增加与 AC 组亚临床心脏毒性风险降低相关（优势比：0.364，95%可信区间 0.136-0.971，p=0.044）。
在蒽环类药物化疗期间测量 EAT 可能有助于识别易发生化疗引起的心脏毒性的亚组。早期检测 EAT 体积变化可使患者接受具有心脏毒性预防策略的个体化化疗。
