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Increased EAT volume after anthracycline chemotherapy is associated with a low risk of cardiotoxicity in breast cancer

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Abstract

Purpose

Chemotherapy-induced cardiotoxicity is a critical issue for patients with breast cancer. Change of epicardial adipose tissue (EAT) is associated with cardiac dysfunction. The objective of this study was to investigate the relationship between EAT and chemotherapy-induced cardiotoxicity.

Methods

This retrospective study analyzed EAT on chest computed tomography (CT) of patients with early breast cancer using automatic, quantitative measurement software between November 2015 and January 2020. Changes in EAT before and after initiation of chemotherapy were compared according to the type of anticancer drug. Subclinical cardiotoxicity was defined as worsening ≥ 10% in left ventricular ejection fraction to an absolute value > 50% with a lower limit of normal measured with standard echocardiography.

Results

Among 234 patients with breast cancer, 85 were treated with adjuvant anthracycline-based (AC) and 149 were treated with non-anthracycline-based (non-AC) chemotherapy. There was a significant increase in EAT volume index (mL/kg/m2) at the end of chemotherapy compared to that at the baseline in the AC group (3.33 ± 1.53 vs. 2.90 ± 1.52, p < 0.001), but not in the non-AC group. During the follow-up period, subclinical cardiotoxicity developed in 20/234 (8.6%) patients in the total population [13/85 (15.3%) in the AC group and 7/149 (4.8%) in the non-AC group]. In the multivariable analysis, EAT volume index increment after chemotherapy was associated with a lower risk of subclinical cardiotoxicity in the AC group (Odds ratio: 0.364, 95% CI 0.136–0.971, p = 0.044).

Conclusions

Measurement of EAT during anthracycline-based chemotherapy might help identify subgroups who are vulnerable to chemotherapy-induced cardiotoxicity. Early detection of EAT volume change could enable tailored chemotherapy with cardiotoxicity prevention strategies.

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Data availability

The data underlying this article cannot be shared publicly to protect the privacy of individuals who participated in the study. The data will be shared on reasonable request to the corresponding author.

References

  1. Choi JY et al (2018) Incidence and risk factors for congestive heart failure in patients with early breast cancer who received anthracycline and/or trastuzumab: a big data analysis of the Korean Health Insurance Review and Assessment service database. Breast Cancer Res Treat 171(1):181–188

    Article  CAS  Google Scholar 

  2. Henriksen PA (2018) Anthracycline cardiotoxicity: an update on mechanisms, monitoring and prevention. Heart 104(12):971–977

    Article  CAS  Google Scholar 

  3. Heck SL et al (2021) Prevention of cardiac dysfunction during adjuvant breast cancer therapy (PRADA): extended follow-up of a 2×2 factorial, randomized, placebo-controlled, double-blind clinical trial of candesartan and metoprolol. Circulation 143(25):2431–2440

    Article  CAS  Google Scholar 

  4. Iacobellis G (2015) Local and systemic effects of the multifaceted epicardial adipose tissue depot. Nat Rev Endocrinol 11(6):363–371

    Article  CAS  Google Scholar 

  5. Mahabadi AA et al (2013) Association of epicardial fat with cardiovascular risk factors and incident myocardial infarction in the general population: the Heinz Nixdorf recall study. J Am Coll Cardiol 61(13):1388–1395

    Article  Google Scholar 

  6. Monti CB et al (2021) Potential role of epicardial adipose tissue as a biomarker of anthracycline cardiotoxicity. Insights Imaging 12(1):161

    Article  Google Scholar 

  7. Seidman A et al (2002) Cardiac dysfunction in the trastuzumab clinical trials experience. J Clin Oncol 20(5):1215–1221

    Article  CAS  Google Scholar 

  8. Arangalage D et al (2019) Epicardial adipose tissue volume is associated with left ventricular remodelling in calcific aortic valve stenosis. Arch Cardiovasc Dis 112(10):594–603

    Article  Google Scholar 

  9. World Health Organization Regional Office for the Western Pacific, The Asia-Pacific perspective: redefining obesity and its treatment. 2000, Sydney, Australia: Health Communications Australia

  10. Oikonomou EK et al (2018) Non-invasive detection of coronary inflammation using computed tomography and prediction of residual cardiovascular risk (the CRISP CT study): a post-hoc analysis of prospective outcome data. Lancet 392(10151):929–939

    Article  Google Scholar 

  11. Okayama S et al (2012) The influence of effective energy on computed tomography number depends on tissue characteristics in monoenergetic cardiac imaging. Radiol Res Pract 2012:150980

    PubMed  PubMed Central  Google Scholar 

  12. Nagayama Y et al (2019) Epicardial fat volume measured on nongated chest CT is a predictor of coronary artery disease. Eur Radiol 29(7):3638–3646

    Article  Google Scholar 

  13. Dobson R et al (2021) BSE and BCOS guideline for transthoracic echocardiographic assessment of adult cancer patients receiving anthracyclines and/or trastuzumab. JACC CardioOncol 3(1):1–16

    Article  Google Scholar 

  14. Lang RM et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the European association of cardiovascular imaging. J Am Soc Echocardiogr 28(1):1-39.e14

    Article  Google Scholar 

  15. Henderson IC et al (2003) Improved outcomes from adding sequential Paclitaxel but not from escalating doxorubicin dose in an adjuvant chemotherapy regimen for patients with node-positive primary breast cancer. J Clin Oncol 21(6):976–983

    Article  CAS  Google Scholar 

  16. Kim H et al (2018) Diagnosis, treatment, and prevention of cardiovascular toxicity related to anti-cancer treatment in clinical practice: an opinion paper from the working group on cardio-oncology of the korean society of echocardiography. J Cardiovasc Ultrasound 26(1):1–25

    Article  Google Scholar 

  17. Sarin S et al (2008) Clinical significance of epicardial fat measured using cardiac multislice computed tomography. Am J Cardiol 102(6):767–771

    Article  Google Scholar 

  18. Doesch C et al (2010) Bioimpedance analysis parameters and epicardial adipose tissue assessed by cardiac magnetic resonance imaging in patients with heart failure. Obesity (Silver Spring) 18(12):2326–2332

    Article  Google Scholar 

  19. Iacobellis G et al (2014) Epicardial fat in atrial fibrillation and heart failure. Horm Metab Res 46(8):587–590

    Article  CAS  Google Scholar 

  20. Pugliese, NR, et al (2021) Impact of epicardial adipose tissue on cardiovascular haemodynamics, metabolic profile, and prognosis in heart failure. Eur J Heart Fail 23(11):1858-1871

  21. Packer M (2018) Leptin-aldosterone-neprilysin axis: identification of its distinctive role in the pathogenesis of the three phenotypes of heart failure in people with obesity. Circulation 137(15):1614–1631

    Article  CAS  Google Scholar 

  22. Sacks HS et al (2009) Uncoupling protein-1 and related messenger ribonucleic acids in human epicardial and other adipose tissues: epicardial fat functioning as brown fat. J Clin Endocrinol Metab 94(9):3611–3615

    Article  CAS  Google Scholar 

  23. Baba S et al (2010) CT Hounsfield units of brown adipose tissue increase with activation: preclinical and clinical studies. J Nucl Med 51(2):246–250

    Article  Google Scholar 

  24. Antonopoulos AS et al (2017) Detecting human coronary inflammation by imaging perivascular fat. Sci Transl Med 9:398

    Article  Google Scholar 

  25. Walker J et al (2010) Role of three-dimensional echocardiography in breast cancer: comparison with two-dimensional echocardiography, multiple-gated acquisition scans, and cardiac magnetic resonance imaging. J Clin Oncol 28(21):3429–3436

    Article  Google Scholar 

  26. Thavendiranathan P et al (2014) Use of myocardial strain imaging by echocardiography for the early detection of cardiotoxicity in patients during and after cancer chemotherapy: a systematic review. J Am Coll Cardiol 63(25):2751–2768

    Article  Google Scholar 

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Acknowledgements

This research was partly supported by the Bio & Medical Technology Development Program of the National Research Foundation of Korea (NRF) funded by the Korean government (MSIT) (NRF-2022R1A2C1007571, NRF-2022R1G1A1009823), and the Soonchunhyang University research fund.

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Author notes

  1. Seong Soon Kwon and Bo Da Nam contributed equally to this article.

Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea

    Seong Soon Kwon, Byoung-Won Park & Duk Won Bang

  2. Department of Radiology, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea

    Bo Da Nam

  3. Division of Hematology and Medical Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea

    Min-Young Lee

  4. Department of Surgery, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea

    Min Hyuk Lee & Jihyoun Lee

  5. Division of Nephrology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Republic of Korea

    Soon Hyo Kwon

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  1. Seong Soon Kwon
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  2. Bo Da Nam
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Contributions

SHK contributed to conceptualization and methodology. SSK contributed to formal analysis, visualization, and writing—original draft. BDN contributed to formal analysis and data curation. M-YL, MHL, B-WP, and DWB contributed to writing—review and editing. All authors read and approved the final manuscript.

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Correspondence to Soon Hyo Kwon.

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Kwon, S.S., Nam, B.D., Lee, MY. et al. Increased EAT volume after anthracycline chemotherapy is associated with a low risk of cardiotoxicity in breast cancer. Breast Cancer Res Treat 196, 111–119 (2022). https://doi.org/10.1007/s10549-022-06696-z

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  • DOI: https://doi.org/10.1007/s10549-022-06696-z

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