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Updated: Dec 11, 2025
Calcification of Vascular Smooth Muscle Cells and Imaging of Aortic Calcification and Inflammation
Published on: May 31, 2016
Coronary and aortic calcification are associated with cardiovascular events on immune checkpoint inhibitor therapy
Walter B Schiffer1, Elena Deych2, Daniel J Lenihan3
1Department of Internal Medicine, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO, United States of America.
Insights
Vascular calcification on baseline CT scans is linked to cardiovascular events after immune checkpoint inhibitor (ICI) therapy. This finding helps identify patients at higher risk for heart issues during cancer treatment.
Area of Science:
- Cardio-Oncology
- Cardiovascular Imaging
- Cancer Therapeutics
Background:
- Immune checkpoint inhibitors (ICIs) can cause cardiovascular (CV) toxicity, but the overall CV event burden and risk factors remain unclear.
- Identifying patients at risk for CV events after ICI therapy is crucial for patient management.
Purpose of the Study:
- To investigate the association between vascular calcification detected on routine baseline computed tomography (CT) imaging and the occurrence of CV events in patients treated with ICIs.
- To identify potential risk factors for CV events following ICI treatment.
Main Methods:
- A retrospective cohort study included 76 patients previously treated with ICIs.
- Coronary and aortic calcification were qualitatively assessed on baseline non-gated chest and abdominal CT scans.
- The study evaluated the association of vascular calcification and clinical parameters with major CV events, including heart failure, acute coronary syndrome, myocarditis, arrhythmia, and pericardial effusion.
Main Results:
- Over 11 months, 80 CV events occurred in 49 patients.
- Worse coronary and aortic calcification on pre-treatment CT scans were significantly associated with CV events (p=0.018 and p=0.014, respectively).
- No differences in traditional CV risk factors were observed between patients with and without CV events.
Conclusions:
- Symptomatic heart failure was the most frequent CV event post-ICI therapy.
- Baseline vascular calcification on CT imaging is a significant predictor of CV events following ICI treatment.
- Selected patients who experience non-myocarditis or non-symptomatic systolic heart failure CV events may be safely re-challenged with ICIs after careful evaluation.
Background:
Although the incidence of immune checkpoint inhibitor (ICI)-related cardiovascular (CV) toxicity is low, the overall burden of CV events after ICI is unknown. Risk factors for CV events after ICI have yet to be identified.
Objectives:
We sought to evaluate the association between vascular calcification on routine baseline computed tomography (CT) imaging and CV events following ICI.
Method:
This was a single-center, retrospective cohort study of 76 patients referred to Cardio-Oncology with prior ICI treatment. Coronary and aortic calcification on non-gated chest and abdominal CT imaging were qualitatively assessed. The association of baseline clinical parameters and vascular calcification with symptomatic heart failure (HF), acute coronary syndrome, myocarditis, symptomatic arrhythmia, or pericardial effusion after ICI was evaluated.
Results:
Over 11 months of follow-up, there were 80 CV events that occurred in 49 patients. Worse coronary and aortic calcification on pre-treatment CT imaging was seen in patients with a CV event (p = .018 and p = .014, respectively). There were no differences in traditional CV risk factors between those with and without a CV event. Eighteen patients (37%) were restarted on ICI therapy after a non- myocarditis or symptomatic systolic HF CV event without recurrent events or mortality over 13 months of follow-up.
Conclusions:
Symptomatic HF was the most common CV event seen after ICI therapy. Worse coronary and aortic calcification on baseline CT imaging was associated with CV events following ICI. With careful clinical evaluation, selected patients may be re-treated with ICI following a non- myocarditis or symptomatic systolic HF CV event.
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