Serial assessment of coronary artery inflammation using cardiac CT in anthracycline chemotherapy for breast cancer.

OBJECTIVES

There is limited evidence of the pericoronary fat attenuation index (FAI) as an imaging marker to assess cancer therapy-related cardiovascular toxicity. We aimed to measure FAI in four consecutive coronary CT angiography (CTA) scans before and 3, 6, and 12 months after anthracycline treatment in patients with breast cancer to determine trends in dynamic changes in FAI after treatment.

METHODS

We performed a post hoc analysis of a prospective study (between August 2019 and July 2020) in which anthracycline-induced myocardial injury was evaluated using cardiac CT. FAI was quantified using coronary CTA images before and 3, 6, and 12 months after anthracycline treatment. The FAIs of the three coronary arteries were averaged to calculate the FAI (Total).

RESULTS

FAI was analyzed on 14 patients with breast cancer who had adequate CT image quality (mean age, 62 years ± 11 (SD); 14 women). During the observation period, all 14 patients treated with anthracycline developed mild asymptomatic cardiac dysfunction related to cancer treatment (CTRCD). FAI (Total) showed a gradual increase during the observation period compared to baseline (baseline: -77.3 ± 5.6 HU, 3 months: -77.1 ± 4.8 HU, 6 months: -76.5 ± 5.4 HU, 12 months: -73.8 ± 5.8 HU). FAI (Total) was significantly elevated at 12 months compared to baseline (p < 0.001).

CONCLUSION

In patients with breast cancer, FAI showed a gradual increase at 3, 6, and 12 months after treatment with anthracyclines compared to before treatment. FAI may be used as an imaging biomarker of coronary artery inflammation in the follow-up of anthracycline therapy and may contribute to the personalization of therapy through early detection of coronary toxicity.

KEY POINTS

Question Is pericoronary fat attenuation index (FAI) a potential imaging biomarker for assessing changes in pericoronary adipose tissue related to cancer therapy-related cardiovascular toxicity? Findings In 14 patients with breast cancer, FAI showed a gradual increase at 3, 6, and 12 months after treatment with anthracyclines compared to before treatment. Clinical relevance FAI may be an imaging biomarker for the detection and treatment of cancer therapy-related cardiovascular toxicity.