Cardiovascular Risk Stratification by Automatic Coronary Artery Calcium Scoring on Pretreatment Chest Computed Tomography in Diffuse Large B-Cell Lymphoma Receiving Anthracycline-Based Chemotherapy: A Multicenter Study
Abstract
Background: Balancing the cardiovascular risk and benefit of anthracycline-based chemotherapy in patients with diffuse large B-cell lymphoma is an important clinical issue. We aimed to evaluate whether the pretreatment coronary artery calcium score (CACS) can stratify the risk of cancer therapy-related cardiac dysfunction (CTRCD) and major adverse cardiovascular events (MACEs) in patients with diffuse large B-cell lymphoma receiving anthracycline-based chemotherapy. Methods: The patients with diffuse large B-cell lymphoma from 4 hospitals were retrospectively enrolled. The CACS was automatically calculated on nongated chest computed tomography before treatment using artificial intelligence-CACS software and divided into 3 categories (0, 1–100, and >100). The associations between the CACS and CTRCD and between the CACS and MACEs were assessed by logistic regression and Fine-Gray competing-risk regression model. Nelson–Aalen cumulative risk curve was performed to assess the cumulative incidence of MACEs. Results: A total of 1468 patients (785 men and 683 women; 100% Asian) were enrolled, and 362 and 185 patients developed CTRCD and MACEs, respectively. Compared with a CACS of 0 (n=826), there was stepwise higher odds of CTRCD with a CACS between 1 and 100 (n=356; odds ratio, 2.587) and a CACS >100 (n=286; odds ratio, 5.239). The CACS was associated with MACEs (1–100 versus 0: subdistribution hazard ratio 3.726; >100 versus 0: subdistribution hazard ratio 7.858; all P <0.001). Competing risk-adjusted MACEs rates for patients with a CACS of 0, 1 to 100, and >100 were 1.21%, 8.43%, and 11.19%, respectively, at 3 years, and 3.27%, 16.01%, 31.12%, respectively, at 5 years. Conclusions: The automatic CACS derived from chest computed tomography before treatment was helpful to identify high-risk patients of CTRCD and MACE and guide clinicians to implement cardiovascular protection strategies in patients with diffuse large B-cell lymphoma who received anthracycline-based chemotherapy.
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AI-CAC was predictive of haemodynamically significant CAD (CT-FFR ≤0.8), postoperative complications, and cancer therapy-related cardiac dysfunction.
“AI-CAC was predictive of haemodynamically significant CAD (CT-Fractional Flow Reserve ≤0.8),28 postoperative complications,21 and cancer therapy-related cardiac dysfunction.24”
From Prognostication and clinical opportunities with AI for coronary artery calcium: a scoping review (2026) · cites this paper as [24]
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- Authors
- Shen, H., Lian, Y., Yin, J., Zhu, M., Yang, C., Tu, C., Peng, Y., Li, X., & Zhang, J.
- Affiliations
- Chongqing University (CN)
- First Affiliated Hospital of Zhengzhou University (CN)
- Guangzhou Medical University (CN)
- Corresponding author
- Shen, Hesong
- Lian, Yanbang
- Yin, Jinxue
- Venue
- Circulation: Cardiovascular Imaging
- Published
- 2023-02
- Volume
- 16
- Issue
- 2
- Pages
- e014829-e014829
- ISSN
- 1941-9651 (ISSN-L)
- 1942-0080
- OpenAlex
- W4319334056
- Cited by
- 30
- References
- 29
- Citations by year
- 2026: 8 · 2025: 12 · 2024: 8 · 2023: 2
- FWCI
- 5.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation Cardiovascular Imaging (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Chemotherapy-induced cardiotoxicity and mitigation
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac tumors and thrombi
- Keywords
- coronary artery calcium score, diffuse large B-cell lymphoma, anthracycline chemotherapy, cancer therapy-related cardiac dysfunction, major adverse cardiovascular events, cardiovascular risk stratification, artificial intelligence, chest CT, cardiotoxicity, risk prediction model, competing risk analysis, cumulative incidence function, lymphoma treatment outcomes, Asian patients
- MeSH terms
- Heart Disease Risk Factors, Artificial Intelligence, Calcium, Cardiovascular Diseases, Coronary Artery Disease, Female, Humans, Male, Predictive Value of Tests, Prognosis, Retrospective Studies, Risk Factors, Tomography, X-Ray Computed, Lymphoma, Large B-Cell, Diffuse, Coronary Angiography, Risk Assessment, Anthracyclines, Vascular Calcification
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