CT FFR decreased and FAI increased after chemotherapy or chemoradiotherapy in individuals with ESCC, and baseline FAI was a predictor of MACEs.
Key Findings
Results
CT fractional flow reserve (FFR) decreased after chemotherapy or chemoradiotherapy in patients with esophageal squamous cell carcinoma.
140 participants were prospectively enrolled between July 2020 and August 2022 (mean age 65 years ± 8.39; 54% male)
60 received chemotherapy and 80 received chemoradiotherapy
CT FFR values decreased in all three major coronary arteries (LAD, LCX, RCA) following treatment
Lower CT FFR was observed after chemoradiotherapy than after chemotherapy (LAD: 0.75 vs 0.82; LCX: 0.74 vs 0.77; RCA: 0.74 vs 0.77; P < .001)
Results
Fat attenuation index (FAI) increased after chemotherapy or chemoradiotherapy in patients with esophageal squamous cell carcinoma.
FAI increased in all three major coronary arteries following treatment
Higher FAI (less negative HU values, indicating greater perivascular fat inflammation) was observed after chemoradiotherapy than after chemotherapy
FAI values after chemoradiotherapy vs chemotherapy: LAD -70.0 vs -75.0 HU; LCX -75.0 vs -77.5 HU; RCA -76.0 vs -78.5 HU (P < .001)
Results
Chemoradiotherapy was associated with greater adverse coronary artery changes than chemotherapy alone.
Both CT FFR reduction and FAI elevation were more pronounced in the chemoradiotherapy group (n=80) compared to the chemotherapy-only group (n=60)
Statistically significant differences between the two treatment groups were observed for both CT FFR and FAI across all three coronary arteries (P < .001)
This suggests that radiation exposure contributes additional cardiovascular stress beyond chemotherapy alone
Results
Baseline FAI of all three major coronary arteries was independently associated with occurrence of major adverse cardiovascular events (MACEs).
MACEs were defined as myocardial infarction, stroke, complete heart block, cardiovascular death, or rehospitalization due to heart failure or aggravated angina symptoms
Cox regression analyses identified baseline FAI as an independent predictor of MACEs
Hazard ratios for baseline FAI of LAD, LCX, and RCA were 3.99, 3.85, and 3.41, respectively (P < .001)
Outcome time frame was measured from treatment initiation until occurrence of MACEs or end of follow-up, whichever occurred first
What This Means
This research suggests that cancer treatments — specifically chemotherapy and chemoradiotherapy — used for esophageal cancer cause measurable changes in the coronary (heart) arteries. Using a specialized CT scan technique called coronary CT angiography (CCTA), researchers tracked 140 patients over approximately two years and found that after treatment, blood flow indicators in the coronary arteries worsened (lower CT-derived fractional flow reserve) and markers of inflammation around the arteries increased (higher fat attenuation index, or FAI). These changes were more pronounced in patients who received radiation therapy in addition to chemotherapy compared to those who received chemotherapy alone.
Importantly, the study found that a patient's FAI measurement taken before treatment began could predict their risk of serious heart events — including heart attacks, stroke, heart block, cardiovascular death, and hospitalization for heart failure — during and after treatment. Patients with higher baseline FAI values in any of the three main coronary arteries had roughly 3.4 to 4 times the risk of experiencing one of these major cardiovascular events compared to those with lower baseline values.
This research suggests that CCTA imaging before starting cancer treatment may help identify esophageal cancer patients who are at elevated cardiovascular risk, potentially allowing doctors to take preventive measures or tailor treatment approaches. It highlights that the heart health consequences of cancer treatment are measurable through imaging and that pre-treatment coronary artery inflammation may be a useful early warning signal for future cardiac complications.
Yang R, Xu Q, Tu C, Xie Y, Liu T, Li X, et al.. (2026). Evaluating Coronary Arteries and Predicting Major Adverse Cardiovascular Events in Patients with Esophageal Cancer Using Coronary CT Angiography.. Radiology. Cardiothoracic imaging. https://doi.org/10.1148/ryct.240534