Myocardial extracellular volume derived from contrast-enhanced chest computed tomography for longitudinal evaluation of cardiotoxicity in patients with breast cancer treated with anthracyclines

Abstract Objectives To assess the value of myocardial extracellular volume (ECV) derived from contrast-enhanced chest computed tomography (CT) for longitudinal evaluation of cardiotoxicity in patients with breast cancer (BC) treated with anthracycline (AC). Materials and methods A total of 1151 patients with BC treated with anthracyclines, who underwent at least baseline, and first follow-up contrast-enhanced chest CT were evaluated. ECV and left ventricular ejection fraction (LVEF) were measured before (ECV 0 , LVEF 0 ), during ((ECV 1 , LVEF 1 ) and (ECV 2 , LVEF 2 )), and after (ECV 3 , LVEF 3 ) AC treatment. ECV values were evaluated at the middle of left ventricular septum on venous phase images. Cancer therapy-related cardiac dysfunction (CTRCD) was recorded. Results Mean baseline LVEF values were 65.85% ± 2.72% and 102 patients developed CTRCD. The mean ECV 0 was 26.76% ± 3.03% (N 0 = 1151). ECV 1 , ECV 2 , and ECV 3 (median interval: 61 (IQR, 46–75), 180 (IQR, 170–190), 350 (IQR, 341–360) days from baseline) were 31.32% ± 3.10%, 29.60% ± 3.24%, and 32.05% ± 3.58% (N 1 = 1151, N 2 = 841, N 3 = 511). ECV 1 , ECV 2 , and ECV 3 were significantly higher than ECV 0 ( p < 0.001). ECV 0 and ECV 1 showed no difference between CTRCD (+) and CTRCD (−) group ( p 1 = 0.150; p 2 = 0.216). However, ECV 2 and ECV 3 showed significant differences between the two groups ( p 3 < 0.001; p 4 < 0.001). Conclusion CT-derived ECV is a potential biomarker for dynamic monitoring AC cardiotoxicity in patients with BC.