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. 2025 Mar 11:15:1552908.
doi: 10.3389/fonc.2025.1552908. eCollection 2025.

Mapping clinical and imaging factors that might predict cardiac events in breast cancer patients

Eugenia Otero-Pla  1   2   3 , Maria Josefa Fuentes Raspall  2 , Pedro Gallego Franco  3   4 , Juan Fernández Martínez  3   5 , Ignasi Gich Saladich  3   6   7 , Nuria Jornet Sala  1   3   4 , Maria Lizondo Gisbert  8 , Jady Rojas Cordero  1   2   3 , Josep Isern Verdum  2 , Gemma Sancho-Pardo  1   2   3
Affiliations

Mapping clinical and imaging factors that might predict cardiac events in breast cancer patients

Eugenia Otero-Pla et al. Front Oncol. .

Abstract

Background: Breast cancer is the most common in women, with a 90% overall survival at 5 years. Cardiotoxicity is a side effect that can modify their morbidity and mortality. Its low prevalence and long latency period have challenged the establishment of a strategy for early detection and prevention.

Objectives: To investigate the association between coronary artery calcium (CAC) in planning computed tomography (CT) and cardiac events.

Methods: Retrospective cohort of 873 breast cancer patients (460 right-side; 413 left-side) treated with radiotherapy (2013-2022). We extract the Hounsfield Unit to quantify the CAC degree from the heart structure in the planning CT. We used IBM-SPSS software (V 29.0 Armonk, NY) for the statistical analysis.

Results: After a median follow-up of 4.52 years (range: 2.42-6.22 years), the cardiac events incidence was 1.95% vs 5.1% in right and left breast cancer, respectively. The mean heart dose was higher in cases with cardiac events (6.74Gy vs 2.28Gy; p<0.01). CAC score>0 was detected in 32.76% of planning CT and was more frequent in the elderly and those with cardiovascular risk factors (p<0.01). Patients with cardiac events presented a CAC score>0 in 41.4% of cases. However, the overall survival in these patients did not differ from those without CAC (p=0.58).

Conclusions: Patients with cardiovascular risk factors and a mean cardiac dose greater than 5 Gy are at increased risk of cardiotoxicity and should be referred for Cardio-Oncology evaluation. The application of the CAC score in CT planning could be a valuable screening test that requires further study.

Keywords: breast cancer; cardiotoxicity; coronary artery calcium; planning CT; radiotherapy.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Overall survival in breast cancer patients with cardiovascular events and CAC. CAC score =0: patients who have not presented CAC in the planning CT; CAC score >0: patients who presented CAC.
See this image and copyright information in PMC

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