SAGE-Hindawi Access to Research Cardiology Research and Practice Volume 2011, Article ID 268058, 7 pages doi:10.4061/2011/268058 Clinical Study Impact of Cardiac Computed Tomographic Angiography Findings on Planning of Cancer Therapy in Patients with Concomitant Structural Heart Disease Iyad N. Daher, Jose Banchs, Syed Wamique Yusuf, Elie Mouhayar, Jean-Bernard Durand, and Gregory Gladish The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA Correspondence should be addressed to Iyad N. Daher, indaher@mdanderson.org Received 22 September 2010; Accepted 26 January 2011 Academic Editor: Daniel J. Lenihan Copyright © 2011 Iyad N. Daher et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Exclusion of underlying coronary artery disease (CAD) is essential in the diagnosis of chemotherapy-induced cardiomyopathy. Presence and severity of CAD can also impact the choice of therapy in cancer patients. The value of cardiac computed tomographic angiography (CCTA) in this setting has not been reported. Methods. We collected data on the clinical presentation and indications for CCTA performed from January to December 2008 at the University of Texas MD Anderson Cancer Center (MDACC). All examinations were performed using a 64-detector scanner. CCTA results and subsequent treatment decisions were examined. Results. A total of 80 patients underwent CCTA during the study period for the following indications (not mutually exclusive): cardiomyopathy of unknown etiology in 33 pts (41.3%), chest pain in 32 (40.0%), abnormal stress test in 16 (20.0%), abnormal cardiac markers in 8 (10.0%), suspected cardiac mass or thrombus in 7 (8.8%). Chemotherapy-induced cardiomyopathy was diagnosed in 18 pts (22.5%). Severe CAD was detected in 22 pts (27.5%); due to concomitant advanced cancer or patient refusal, only 12 underwent coronary angiogram. Of these, 4 pts (5% of total) underwent coronary artery bypass grafting. A total of 41 pts (51.3%) had their cancer management altered based on CCTA ﬁndings. Conclusion. CCTA is useful in evaluating cancer pts with structural heart disease and can have an impact on the management of cancer and cardiac disease. 1. Introduction Suspected coronary artery disease (CAD) in patients with a concurrent malignancy greatly impacts prognosis and treatment decisions. Faced with both diseases, appropriate prioritization of care is needed, as some cancer treatments may be cardiotoxic [1] or lead to blood dyscrasias that could discourage the use of commonly prescribed cardiac medications, such as aspirin or heparin products. On the other hand, planning of cardiac invasive testing requires clinicians to take into account cancer status and possible delays in care. Noninvasive coronary anatomical imaging could therefore help with accurate treatment planning prior to using invasive strategies. Exclusion of signiﬁcant obstructive CAD in patients with left ventricular (LV) dysfunction and a prior history of expo- sure to cardiotoxic chemotherapy agents are both needed for the diagnosis of chemotherapy-induced cardiomyopathy (CIC) [2]. In addition, some cancer patients presenting with other ﬁndings suggestive of structural heart disease may need an accurate anatomical coronary evaluation. While invasive coronary angiography (ICA) remains the procedure of choice in patients with high pretest probability of CAD, it is not always justiﬁed in those with low to intermediate suspicion of CAD [3]. It also carries a risk of bleeding or infectious complications, which may be more likely in cancer patients because of blood dyscrasias or immunosuppression. Ongoing chemotherapy or radiation treatment may also further delay ICA. There is therefore a need for an accu- rate noninvasive modality to deﬁne the coronary anatomy in some cancer patients. Cardiac computed tomographic angiography (CCTA) is such a modality, and has been shown to correlate well with ICA [4–6]. Speciﬁcally, its negative predictive value in excluding CAD in the presence