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Background <p>Anthracyclines and HER2-directed therapies improve survival in early breast cancer but increase cardiovascular risk, which body mass index poorly characterizes. We evaluated longitudinal associations between pre-treatment CT-derived body composition and echocardiography-derived systolic and diastolic function in a prospective cohort of women with early breast cancer.</p> Methods <p>In a prospective cohort of women with stage I–III early breast cancer treated with anthracyclines and/or trastuzumab, skeletal muscle index (SMI), muscle density (SMD), and visceral and subcutaneous adipose tissue area and density (VAT, SAT, VATD, SATD) were quantified from pre-treatment CT or PET-CT at L3 using automated segmentation. Longitudinal changes in LVEF and E/e′ were analyzed using multivariable-adjusted GEE models. Time to incident systolic dysfunction (≥ 10% LVEF decline to &lt; 50%) and diastolic dysfunction (E/e′ ≥ 14) were analyzed using Cox proportional hazards models.</p> Results <p>Across 177 participants (median age 50&#xa0;years, 36.2% HER2-positive, 19.9% triple-negative), 145 (81.9%) received anthracycline-based therapy. Baseline body composition was not associated with longitudinal LVEF change. Higher baseline VAT (β 0.6, 95% CI 0.2–0.9; <i>p</i> = 0.001) and VAT/SAT ratio (β 0.5, 95% CI 0.2–0.7; <i>p</i> &lt; 0.001) were associated with increased E/e′ over time, while higher VATD (β − 0.4, 95% CI − 0.6 to − 0.1; <i>p</i> = 0.002) was associated with decreased E/e′ during follow-up. No associations were observed for SAT or SATD.</p> Conclusions <p>Pre-treatment visceral adiposity is associated with worsening diastolic function during breast cancer therapy. CT-derived body composition may refine cardiotoxicity risk assessment beyond BMI.</p>

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The association between adiposity and cardiac function in patients with early breast cancer receiving cardiotoxic therapies

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月21日

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  • Gabriel Aleixo,
  • Wei Ting Hwang,
  • Rakesh Sharma,
  • Wonyoung Jung,
  • Congying Xia,
  • Vivek Narayan,
  • Yehoda M. Martei,
  • Ramy Sedhom,
  • Walter Witschey,
  • Bonnie Ky

摘要

Background

Anthracyclines and HER2-directed therapies improve survival in early breast cancer but increase cardiovascular risk, which body mass index poorly characterizes. We evaluated longitudinal associations between pre-treatment CT-derived body composition and echocardiography-derived systolic and diastolic function in a prospective cohort of women with early breast cancer.

Methods

In a prospective cohort of women with stage I–III early breast cancer treated with anthracyclines and/or trastuzumab, skeletal muscle index (SMI), muscle density (SMD), and visceral and subcutaneous adipose tissue area and density (VAT, SAT, VATD, SATD) were quantified from pre-treatment CT or PET-CT at L3 using automated segmentation. Longitudinal changes in LVEF and E/e′ were analyzed using multivariable-adjusted GEE models. Time to incident systolic dysfunction (≥ 10% LVEF decline to < 50%) and diastolic dysfunction (E/e′ ≥ 14) were analyzed using Cox proportional hazards models.

Results

Across 177 participants (median age 50 years, 36.2% HER2-positive, 19.9% triple-negative), 145 (81.9%) received anthracycline-based therapy. Baseline body composition was not associated with longitudinal LVEF change. Higher baseline VAT (β 0.6, 95% CI 0.2–0.9; p = 0.001) and VAT/SAT ratio (β 0.5, 95% CI 0.2–0.7; p < 0.001) were associated with increased E/e′ over time, while higher VATD (β − 0.4, 95% CI − 0.6 to − 0.1; p = 0.002) was associated with decreased E/e′ during follow-up. No associations were observed for SAT or SATD.

Conclusions

Pre-treatment visceral adiposity is associated with worsening diastolic function during breast cancer therapy. CT-derived body composition may refine cardiotoxicity risk assessment beyond BMI.