3543 - Pre-Treatment Cardiovascular Risk Profile in Esophageal Cancer Patients: A Comparative Analysis with Other Thoracic Malignancies

02:30pm - 03:45pm PT

Hall F

Screen: 11

POSTER

Presenter(s)

Akinori Takada, MD, PhD - Mie university, Tsu, Mie

A. Takada Sr¹, Y. Toyomasu¹, T. Mase¹, K. Omori¹, A. Taniguchi¹, K. Saihara¹, S. Nakamura², and Y. Nomoto¹; ¹Department of Radiology, Mie University Hospital, Tsu, Mie, Japan, ²Department of Advanced Diagnostic Imaging, Mie University Graduate School of Medicine, Tsu, Mie, Japan

Purpose/Objective(s): With advancements in cancer treatment, the incidence of long-term cardiovascular complications following therapy has been increasing, highlighting the importance of pre-treatment cardiac assessment. Notably, esophageal cancer and cardiovascular disease share several risk factors. Additionally, radiation therapy for esophageal cancer is associated with higher cardiac radiation exposure compared to other malignancies, and an increased incidence of cardiac-related mortality has been reported. In this study, we aim to prospectively evaluate the presence of pre-existing cardiac dysfunction using pre-treatment cardiac computed tomography (CT), specifically CT myocardial perfusion (CTP), in patients undergoing thoracic irradiation at our institution and to compare the findings between esophageal cancer and other malignancies.

Materials/Methods: A total of 73 patients with thoracic malignancies who were referred for radiation therapy at our institution between January 2017 and April 2024 underwent pre-treatment cardiac CT for cardiac assessment. Coronary artery stenosis was evaluated using the Coronary Artery Disease Reporting and Data System (CAD-RADS), while valvular disease and myocardial ischemia were also assessed. Additionally, echocardiographic evaluation was performed in cases where further assessment was deemed necessary.

Results: The median age of the 73 patients was 68 years, with 50 (68%) being male. The distribution of malignancies was as follows: esophageal cancer (44 cases), breast cancer (19 cases), malignant lymphoma (7 cases), and lung cancer (3 cases). Significant coronary artery stenosis, as assessed by CAD-RADS, was observed in 43%, 5%, 14%, and 33% of cases, respectively, while a high coronary artery calcium (Ca) score (>400) was noted in 32%, 0%, 0%, and 0%, respectively. Among 63 patients who underwent pre- and post-radiation serum BNP measurements, 36 (57%) exhibited abnormal values. Additionally, echocardiographic assessment in 46 patients revealed reduced ejection fraction (EF) in 6 (13%) cases. Comparative analysis between esophageal cancer and non-esophageal cancer groups demonstrated significantly higher values in the esophageal cancer cohort for the Agatston score (499 vs. 26, p = 0.0068), prevalence of significant coronary artery stenosis (43% vs. 10%, p = 0.0082), and BNP levels (48 pg/mL vs. 16 pg/mL, p = 0.0178).

Conclusion: Among thoracic malignancies, esophageal cancer cases showed a high detection rate of abnormalities on cardiac CT, highlighting the significance of performing pre-treatment evaluation.