Liu Yuyao, Zhang Tingjian, Huang Xiao, Shen Li, Yang Quan
Department of Radiology, Yongchuan Hospital of Chongqing Medical University, 402160 Chongqing, China.
Department of General Surgery, Yongchuan Hospital of Chongqing Medical University, 402160 Chongqing, China.
Rev Cardiovasc Med. 2024 Jul 9;25(7):254. doi: 10.31083/j.rcm2507254. eCollection 2024 Jul.
Cardiotoxicity (CTX) induced by adjuvant chemotherapy is a significant factor that impacts the prognosis and quality of life in breast cancer (BC) patients. In this study, we aimed to investigate the changes in epicardial adipose tissue (EAT) before and after treatment in BC patients who received anthracyclines adjuvant chemotherapy protocol (AC-T) and anthracyclines combined with trastuzumabadjuvant chemotherapy protocol (AC-TH). Additionally, we assessed whether there were any differences in the changes in EAT between the two groups of patients. Our objective was to examine the effects of anthracyclines and trastuzumab on EAT and determine the potential role of EAT changes on CTX.
We reviewed female BC patients who were treated with adjuvant chemotherapy protocols of AC-T and AC-TH, all of whom underwent baseline (T0) and follow-up (T1) chest computed tomography (CT) and echocardiography. A cohort of healthy women, matched in age, underwent two chest CTs. EAT was quantified on chest CT using semi-automated software. CTX was defined as a 10% reduction in left ventricular ejection fraction (LVEF) from baseline, with an absolute value of 53%.
A total of 41 BC patients were included in the study, with 23 patients in the AC-T group and 18 patients in the AC-TH group. Additionally, 22 healthy females were included as the normal group. None of the BC patients developed CTX after chemotherapy. The age did not differ significantly between the normal group and the AC-T group ( = 0.341) or the AC-TH group ( = 0.853). Similarly, the body mass index (BMI) of the normal group was comparable to that of the AC-T group ( = 0.377, 0.346) and the AC-TH group ( 0.148, 0.119) before and after chemotherapy. The EAT volume index (mL/kg/ ) was significantly higher in both the AC-T group (5.11 1.85 vs. 4.34 1.55, 0.001) and the AC-TH group (4.53 1.61 vs. 3.48 1.62, 0.001) at T1 compared with T0. In addition, both the AC-T group (-72.95 5.01 vs. -71.22 3.91, = 0.005) and the AC-TH group (-72.55 5.27 vs. -68.20 5.98, 0.001) exhibited a significant decrease in EAT radiodensity (HU) at T1 compared to T0. However, there was no significant difference observed in the normal group. At T0, no difference was seen in EAT volume index (4.34 1.55 vs. 3.48 1.62, = 0.090) and radiodensity (-71.22 3.91 vs. -68.20 5.98, = 0.059) between the AC-T and AC-TH groups. Similarly, at T1, there was still no significant difference observed in the EAT volume index (-5.11 1.85 vs. 4.53 1.61, = 0.308) and radiodensity (-72.95 5.00 vs. -72.54 5.27, = 0.802) between the two groups.
BC patients who underwent AC-T and AC-TH adjuvant chemotherapy protocols demonstrated a significant rise in the volume index of EAT, along with a substantial reduction in its radiodensity post-chemotherapy. These findings indicate that alterations in EAT could potentially aid in identifying cardiac complications caused by chemotherapeutic agents and remind clinicians to focus on changes in EAT after adjuvant chemotherapy in BC patients to prevent the practical occurrence of CTX.
辅助化疗引起的心脏毒性（CTX）是影响乳腺癌（BC）患者预后和生活质量的重要因素。在本研究中，我们旨在调查接受蒽环类辅助化疗方案（AC-T）和蒽环类联合曲妥珠单抗辅助化疗方案（AC-TH）的BC患者治疗前后心外膜脂肪组织（EAT）的变化。此外，我们评估了两组患者EAT变化是否存在差异。我们的目的是研究蒽环类药物和曲妥珠单抗对EAT的影响，并确定EAT变化对CTX的潜在作用。
我们回顾了接受AC-T和AC-TH辅助化疗方案治疗的女性BC患者，所有患者均接受了基线（T0）和随访（T1）胸部计算机断层扫描（CT）和超声心动图检查。一组年龄匹配的健康女性接受了两次胸部CT检查。使用半自动软件在胸部CT上对EAT进行定量。CTX定义为左心室射血分数（LVEF）较基线降低10%，绝对值≤53%。
本研究共纳入41例BC患者，其中AC-T组23例，AC-TH组18例。此外，纳入22名健康女性作为正常组。化疗后BC患者均未发生CTX。正常组与AC-T组（P = 0.341）或AC-TH组（P = 0.853）年龄差异无统计学意义。同样，化疗前后正常组的体重指数（BMI）与AC-T组（P = 0.377，0.346）和AC-TH组（P = 0.148，0.119）相当。与T0相比，T1时AC-T组（5.11±1.85 vs. 4.34±1.55，P<0.001）和AC-TH组（4.53±1.61 vs. 3.48±1.62，P<0.001）的EAT体积指数（mL/kg/m²）均显著升高。此外，与T0相比，AC-T组（-72.95±5.01 vs. -71.22±3.91，P = 0.005）和AC-TH组（-72.55±5.27 vs. -68.20±5.98，P<0.001）的EAT放射密度（HU）在T1时均显著降低。然而，正常组未观察到显著差异。在T0时，AC-T组和AC-TH组之间的EAT体积指数（4.34±1.55 vs. 3.48±1.62，P = 0.090）和放射密度（-71.22±3.91 vs. -68.20±5.98，P = 0.059）无差异。同样，在T1时，两组之间的EAT体积指数（-5.11±1.85 vs. 4.53±1.61，P = 0.308）和放射密度（-72.95±5.00 vs. -72.54±5.27，P = 0.802）仍无显著差异。
接受AC-T和AC-TH辅助化疗方案的BC患者化疗后EAT体积指数显著升高，放射密度显著降低。这些发现表明，EAT的改变可能有助于识别化疗药物引起的心脏并发症，并提醒临床医生关注BC患者辅助化疗后EAT的变化，以预防CTX的实际发生。
