Expert Consensus Guides Use of Cardiac CT in Patients With Cancer

Expert Consensus Guides Use of Cardiac CT in Patients With Cancer

The Society of Cardiovascular Computed Tomography (SCCT) has issued an expert consensus statement to guide use of cardiac computed tomography (CCT) in the care of cardio-oncology patients.

This statement addresses “gaps in recommendations on the role of CCT in cancer patients and cancer survivors in many existing guidelines and consensus statements from professional societies,” lead author Juan Lopez-Mattei, MD, medical director of cardiac imaging, Lee Health Heart and Vascular Institute, Fort Myers, Florida, told | Medscape Cardiology.

The statement was published online September 15 in Journal of Cardiovascular Computed Tomography (JCCT). It has been endorsed by the International Cardio-Oncology Society (ICOS).

The 72-page statement provides multimodality recommendations from experts in cardiology, radiology, cardiovascular imaging, cardio-oncology, and radiation oncology.

Growing Population at CVD Risk

The number of long-term cancer survivors has been rapidly growing, the authors note. At the same time, many new cancer therapies affect the heart, and cardiovascular disease (CVD) is the leading cause of illness and death among adult cancer survivors.

The expert consensus recommends a comprehensive baseline evaluation to screen for, and subsequently optimize, any underlying atherosclerotic cardiovascular disease (ASCVD) risk factors for all patients with cancer and cancer survivors.

A review of prior (recent) noncardiac chest CT reports and/or images, if available, is highly recommended to assess for subclinical ASCVD. If there is evidence of coronary artery calcium (CAC) in a patient without history of ASCVD, measures should be taken to improve CV risk stratification and reduce ASCVD risk.

This is “one of the most important recommendations” in the document, Lopez-Mattei said.

“Cancer patients tend to have multiple CT imaging and if it includes the chest, there should be an assessment for coronary calcification as there is data showing prognostic information regarding CV events from coronary calcium burden derived from nongated chest CT scans,” he noted.

Another key recommendation is for radiologists and nuclear medicine physicians to start making note of the presence or absence of CAC in their reports and consider assessment of CAC burden quantitatively or qualitatively in noncontrast, nongated CT scans, preferably using the CAC-Data Reporting system (CAC-DRS).

“Hopefully more centers start reporting coronary calcifications in noncardiac studies following our recommendations,” Lopez-Mattei said.

E merging Field of Cardio-Oncology

Co-author Maros Ferencik, MD, Division of Cardiovascular Medicine, Oregon Health & Science University, Portland, noted that CCT has a growing role in the assessment of cardio-oncology patients, but clear guidance on its use in this population was missing.

“At the same time, there has been a lot of new research and clinical observations that has made the work on the expert consensus statement possible,” Ferencik told | Medscape Cardiology.

Lopez-Mattei mentioned that the format of ‘consensus document,’ rather than guideline, was chosen to acknowledge that there are limited scientific data for guideline level standardized recommendations.

“Through a rigorous review process of available literature, we were able to extrapolate recommendations and draw conclusions from available clinical and research evidence and provide guidance for the care of cancer patients and survivors using CCT,” he said.

“We plan to update the document as the field of cardio-oncology and CCT both grow rapidly. It will be updated as needed and hopefully the field grows enough to change this statement from an ‘expert consensus statement’ to a guideline with the next iteration,” he concluded.

This research has no commercial funding. Lopez-Mattei and Ferencik report no relevant financial relationships.

J Cardiovasc Comput Tomogr. Published online September 15, 2022. Full text

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