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Published on: August 17, 2022
Coronary vasomotor dysfunction portends worse outcomes in patients with breast cancer
Sanjay Divakaran1,2, Jesse P Caron2, Wunan Zhou1
1Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, ASB-L1 037C, Boston, MA, 02115, USA.
Insights
In breast cancer patients, impaired Myocardial Flow Reserve (MFR) predicts cardiovascular events. This finding suggests MFR can help stratify risk in this population.
Area of Science:
- Cardiology
- Oncology
- Nuclear Medicine
Background:
- Cardiovascular disease (CVD) is a significant concern for breast cancer patients.
- Impaired Myocardial Flow Reserve (MFR), even without obstructive coronary artery disease (CAD), is linked to adverse cardiovascular outcomes.
Purpose of the Study:
- To evaluate the predictive value of MFR for cardiovascular outcomes in patients with breast cancer.
- To assess the utility of MFR as a risk stratification tool in this specific patient group.
Main Methods:
- Retrospective study of 87 breast cancer patients/survivors who underwent cardiac stress PET imaging (2006-2017).
- Exclusion criteria included overt CAD, low LVEF (<45%), or abnormal perfusion.
- Follow-up for major adverse cardiovascular events (MACE) and all-cause death.
Main Results:
- The cohort had a mean MFR of 2.05, with 98.9% female patients (median age 69).
- Over a median 7.6-year follow-up, the lowest MFR tertile showed a significantly higher incidence of MACE (aHR 4.91; P=0.004) compared to the highest tertile.
Conclusions:
- Coronary vasomotor dysfunction, indicated by impaired MFR, is associated with incident cardiovascular events in breast cancer patients.
- MFR shows potential as a valuable biomarker for risk stratification in patients with or survivors of breast cancer.
Background:
Impaired MFR in the absence of flow-limiting CAD is associated with adverse events. Cardiovascular disease is an important cause of morbidity and mortality in patients with breast cancer. We sought to test the utility of MFR to predict outcomes in a cohort of patients with breast cancer.
Methods:
We retrospectively studied consecutive patients with breast cancer or breast cancer survivors who underwent cardiac stress PET imaging from 2006 to 2017 at Brigham and Women's Hospital. Patients with a history of clinically overt CAD, LVEF < 45%, or abnormal myocardial perfusion were excluded. Subjects were followed from time of PET to the occurrence of a first major adverse cardiovascular event (MACE) and all-cause death.
Results:
The final cohort included 87 patients (median age 69.0 years, 98.9% female, mean MFR 2.05). Over a median follow-up of 7.6 years after PET, the lowest MFR tertile was associated with higher cumulative incidence of MACE (adjusted subdistribution hazard ratio 4.91; 95% CI 1.68-14.38; p = 0.004) when compared with the highest MFR tertile.
Conclusions:
In patients with breast cancer, coronary vasomotor dysfunction was associated with incident cardiovascular events. MFR may have potential as a risk stratification biomarker among patients with/survivors of breast cancer.
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