Table 1.

Proposed Uses of Cardiac CT Along Spectrum of Cancer Treatment

Chemotherapy/Targeted Therapy Type	Examples of Specific Medications	Cardiovascular Side Effects	Role of Cardiac CT
Fluoropyrimidines	5-FU Capecitabine	Anginal chest pain (incidence up to 18%) (55,56,105, 106, 107, 108) more common with infusion of 5-FU Coronary vasospasm Myocardial infarction	•Coronary CTA to rule out acute coronary syndrome •Coronary CTA to evaluate coronary atherosclerosis before therapy •CAC assessment on noncardiac CT scans to assess for subclinical ASCVD
Taxanes	Paclitaxel Docetaxel	Myocardial ischemia (55,56) Coronary vasospasm (109)	•Coronary CTA to rule out acute coronary syndrome
Alkylating agents	Cyclophosphamide	Hemorrhagic myopericarditis	•Cardiac CT to evaluate pericardial effusion •Coronary CTA to rule out obstructive CAD when myocarditis is suspected (eg, elevated troponin)
Immune checkpoint inhibitors	Pembrolizumab Nivolumab Ipilimumab Atezolizumab	Myocarditis (incidence 1%-2%) (84,110, 111, 112, 113, 114, 115, 116) Increased risk of coronary atherosclerosis (117)	•Coronary CTA to rule out obstructive CAD when myocarditis is suspected (eg, elevated troponin) •Coronary CTA to evaluate coronary atherosclerosis before therapy •CAC assessment on noncardiac CT scans
Vascular endothelial growth factor inhibitors	Bevacizumab Sunitinib Sorafenib Pozapanib	Arterial hypertension Acute thromboembolic events (118, 119, 120, 121, 122)	•Coronary CTA to rule out acute coronary syndrome
Anthracyclines	Doxorubicin Daunorubicin Idarubicin Mitoxantrone	Cardiomyopathy Arrhythmia Pericardial effusion	•Coronary CTA to rule out obstructive CAD as an etiology of or contributor to decreased left ventricular systolic function
HER2/neu receptor inhibitors	Trastuzumab	Cardiomyopathy	•Coronary CTA to rule out obstructive CAD as the etiology of or contributor to decreased left ventricular systolic function

ACS = acute coronary syndrome; ASCVD = atherosclerotic cardiovascular disease; CAC = coronary artery calcium scoring; CT = computed tomography; CTA = computed tomography angiography; FU = fluorouracil.