PET/CT-derived coronary calcium score may predict cardiac complications in anthracycline-treated lymphoma patients

Anthracycline-mediated cardiotoxicity is a common concern following lymphoma therapy, particularly in patients with high cardiovascular risk (CVR). In non-cancer populations, coronary artery calcium scoring (CACS) effectively identifies individuals who may benefit from aggressive CVR modification to lower the risk of cardiovascular events. Emerging evidence suggests that CACS can also predict cancer therapy-related cardiotoxicity, potentially identifying candidates for cardioprotective strategies. Our study aimed to evaluate whether CACS, obtained from pre-treatment PET/CT scans, could stratify cardiac event risk in lymphoma patients receiving anthracycline-based chemotherapy. We enrolled 358 consecutive lymphoma patients treated 2012-2022, calculating CACS from their pre-treatment PET/CT. We reviewed medical records to identify pre-existing cardiac conditions, CVR, and post-treatment cardiac events, including coronary events, heart failure (HF), and arrhythmias. Logistic and Cox regression models were used to assess associations between CVR, CACS categories (CACS=0, CACS 1-400, CACS>400), and new cardiac events. At a median follow-up of 27 months (95% CI 22.3-31.7) in patients without cardiac history, 10% experienced post-treatment cardiac events (HF: 14, arrhythmias: 9, coronary event: 1, combination: 8). Patients with CACS>0 had more events (21 total, 20% versus 11 total, 5.4% for CACS=0; p400: OR 5.43, 95% CI 1.47-20.03, p=0.011) and any cardiac event (CACS 1-400: OR 2.48, 95% CI 1.02-6.04, p=0.045; CACS >400: OR 3.28, 95% CI 0.91-10.68, p=0.029). CACS may effectively stratify lymphoma patients at risk of cardiac complications, thereby identifying a group poised to benefit from targeted preventive strategies.