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Coronary vasomotor dysfunction portends worse outcomes in patients with breast cancer

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Journal of Nuclear Cardiology Aims and scope

Abstract

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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Abbreviations

CAC:

Coronary artery calcium

CAD:

Coronary artery disease

LVEF:

Left ventricular ejection fraction

MACE:

Major adverse cardiovascular event

MFR:

Myocardial flow reserve

PET:

Positron emission tomography

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Disclosures

Dr. Dorbala is a member of an advisory board for Proclara, Pfizer, and General Electric Health Care, and receives grant support from Pfizer. Dr. Blankstein receives research support from Amgen Inc. and Astellas Inc. Dr. Groarke receives research support from Amgen, Inc. Dr. Nohria receives research support from Amgen, Inc. and consulting fees from Takeda Oncology, AstraZeneca Pharmaceuticals, and Boehringer Ingelheim. Dr. Di Carli has received investigator-initiated institutional research grant support from Spectrum Dynamics and Gilead Sciences, and consulting fees from Bayer and Janssen. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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Authors and Affiliations

  1. Cardiovascular 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

    Sanjay Divakaran MD, Wunan Zhou MD, MPH, Jon Hainer BS, Courtney F. Bibbo MSc, Hicham Skali MD, MSc, FASNC, Viviany R. Taqueti MD, MPH, FASNC, Sharmila Dorbala MD, MPH, MASNC, Ron Blankstein MD, FASNC & Marcelo F. Di Carli MD, MASNC

  2. Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Sanjay Divakaran MD, Jesse P. Caron BA, Hicham Skali MD, MSc, FASNC, Ron Blankstein MD, FASNC, John D. Groarke MD, MPH, Anju Nohria MD & Marcelo F. Di Carli MD, MASNC

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  1. Sanjay Divakaran MD
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Correspondence to Marcelo F. Di Carli MD, MASNC.

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Funding

Dr. Divakaran and Dr. Zhou were supported by a T32 postdoctoral training grant from the National Heart, Lung, and Blood Institute (T32 HL094301). Dr. Divakaran was also supported by a joint KL2/Catalyst Medical Research Investigator Training (CMeRIT) award from Harvard Catalyst and the Boston Claude D. Pepper Older Americans Independence Center (5P30AG031679-10). Mr. Caron was supported in part by the Goodman Master Clinician Scholar Award (awarded to Dr. Groarke) and the Gelb Master Clinician Scholar Award (awarded to Dr. Nohria). Dr. Taqueti was supported by Grant Number K23 HL135438 from the National Heart, Lung, and Blood Institute. Dr. Dorbala was supported by Grant Number R01 HL130563 from the National Heart, Lung, and Blood Institute. Dr. Di Carli was supported by Grant Number R01 HL132021 from the National Heart, Lung, and Blood Institute.

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Divakaran, S., Caron, J.P., Zhou, W. et al. Coronary vasomotor dysfunction portends worse outcomes in patients with breast cancer. J. Nucl. Cardiol. 29, 3072–3081 (2022). https://doi.org/10.1007/s12350-021-02825-1

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