For patients receiving androgen deprivation therapy (ADT) for prostate cancer (PCa), emerging research affirms that assessing myocardial extracellular volume (ECV) from chest contrast-enhanced computed tomography (CECT) may provide significant utility in monitoring for cardiotoxicity and predicting major adverse cardiovascular events (MACEs).
In a retrospective study, recently published in the European Journal of Radiology, researchers evaluated CECT-derived ECV at baseline and at three, six, nine and 12 months after the initiation of ADT in 180 patients (median age of 70 at first chest CECT) with PCa. Twenty-four percent of the cohort (44 patients) developed MACE, according to the study.
Overall, the study authors noted a significant increase in myocardial ECV three months after ADT initiation (27.93 percent) in comparison to baseline assessment (23.45 percent). However, there was no change in the left ventricular ejection fraction (LVEF) at three months (68.5 percent) and a slight decrease at 12 months (67 percent) after ADT initiation.
Here one can see unenhanced and enhanced CT images showing CT values of the left ventricle and ventricular septum at baseline and at three, six and nine months after administration of androgen deprivation therapy (ADT) for a 66-year-old patient with major adverse cardiovascular events (MACE). (Images courtesy of the European Journal of Radiology.)
“The study results showed that myocardial ECV was gradually increased and LVEF was gradually decreased in PCa patients after receiving ADT, which indicates that ADT is indeed cardiotoxic. The difference between the MACE (+) and MACE (−) groups was statistically significant after 3 months of ADT, but there was no difference in LVEF between the two groups. This proves that myocardial ECV can detect ADT-induced cardiotoxicity earlier than LVEF,” wrote lead study author Xinyu Zhang, M.D., who is affiliated with the Department of Radiology at the Chongqing University Cancer Hospital and Chongqing Cancer Institute in Chongqing, China, and colleagues.
While acknowledging a lack of statistically significant changes at six and nine months, the researchers pointed out that myocardial ECV was nearly 10 percent higher one year after patients started ADT (33.71 percent).
The study authors noted that patients who had MACE had higher myocardial ECV at three, six, nine and 12 months in contrast to patients who did not develop MACE. One year after ADT initiation, those in the MACE cohort had a mean myocardial ECV of 38.80 percent in comparison to 32.06 percent in the non-MACE group.
Three Key Takeaways
- Myocardial ECV detects early cardiotoxicity from ADT. CECT-derived myocardial extracellular volume increased significantly within three months of ADT initiation, preceding measurable changes in LVEF, suggesting ECV is a more sensitive early marker of ADT-related cardiotoxicity.
- Higher ECV predicts major adverse cardiovascular events (MACE). Patients with elevated myocardial ECV had a significantly higher risk of MACE at three, six, and nine months, with risk increasing over time compared to those with lower ECV.
- Clinical utility for monitoring PCa patients on ADT. Serial CECT-derived myocardial ECV measurements may provide a practical tool for early detection and risk stratification of cardiotoxicity in prostate cancer patients receiving ADT, potentially guiding closer cardiovascular surveillance and management.
Patients with high ECV had a 2.695-fold higher risk of MACE at three months, a 3.670-fold higher risk at six months and a 4.450-fold higher risk at nine months in contrast to those with lower ECV, according to the researchers.
“In the future, if more prospective studies can confirm the ability of myocardial ECV derived from chest CECT to predict MACE, it may be the basis for routine chest CECT examination in PCa patients receiving ADT,” posited Zhang and colleagues.
(Editor’s note: For related content, see “Study Examines Potential of Ultra-high Spatial Resolution Photon-Counting CT for Coronary Plaque Quantification,” “The Reading Room Podcast: Emerging Trends with Theranostics in Prostate Cancer, Part 2” and “Multimodal AI with CCTA and MRI Data Shows Promise in Predicting MACE in Patients with Obstructive CAD.”)
Beyond the inherent limitations of a single-center retrospective study, the authors acknowledged a lack of comparison of cardiotoxic effects for different classes of castrating drugs. They also conceded a lack of cardiac biopsies for patients with MACE and the exclusion of patients who died from non-cardiovascular causes during the follow-up period of the study.