{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T09:10:59Z","timestamp":1788858659125,"version":"build-2803163510"},"reference-count":34,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"Youth Fund of the National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["81900443"],"award-info":[{"award-number":["81900443"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"award":["81900443"],"award-info":[{"award-number":["81900443"]}],"id":[{"id":"https:\/\/ror.org\/01h0zpd94","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Cardiovasc. Dev. Dis.","JCDD"],"abstract":"<jats:p>Early identification of patients with breast cancer who are at increased risk of treatment-related myocardial injury may support individualized cardiovascular surveillance. This retrospective study included 551 patients treated at Sun Yat-sen Memorial Hospital between January 2014 and December 2021. All patients had chest computed tomography data and at least three high-sensitivity cardiac troponin T (hs-cTnT) measurements. Early myocardial injury was defined as hs-cTnT &gt; 14 ng\/L within 6 months after treatment. Patients were randomly divided into training (n = 366) and validation (n = 185) cohorts. Candidate predictors were identified using univariable Cox regression and least absolute shrinkage and selection operator regression. A multivariable Cox model was then used to construct the nomogram. Baseline hs-cTnT, high-density lipoprotein cholesterol, thoracic aortic calcification score, and anti-human epidermal growth factor receptor 2 therapy were retained as independent predictors. In the validation cohort, the nomogram showed good discrimination, with an area under the receiver operating characteristic curve of 0.901 and a concordance index of 0.882. Calibration curves indicated agreement between predicted and observed risks. Decision curve analysis suggested clinical utility, while risk stratification identified distinct groups in both cohorts (p &lt; 0.001). This thoracic aortic calcification-based nomogram may support the identification of patients at high risk of early myocardial injury after anticancer therapy.<\/jats:p>","DOI":"10.3390\/jcdd13090445","type":"journal-article","created":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T08:10:22Z","timestamp":1788855022000},"page":"445","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development and Validation of a Thoracic Aortic Calcification-Based Nomogram for Early Myocardial Injury in Breast Cancer Patients"],"prefix":"10.3390","volume":"13","author":[{"given":"Lingqu","family":"Zhou","sequence":"first","affiliation":[{"name":"Department of Ultrasonography and Electrocardiograms, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, 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Center, Guangzhou 510060, China"},{"name":"State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-sen University Cancer Center, Guangzhou 510060, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"Zirui","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Ultrasonography and Electrocardiograms, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China"},{"name":"Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510060, 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China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"}]},{"given":"Qi","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510060, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Yinyin","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510060, 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Heart J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1016\/j.jaccao.2024.07.017","article-title":"Cardiovascular Considerations Before Cancer Therapy: Gaps in Evidence and JACC: CardioOncology Expert Panel Recommendations","volume":"6","author":"Murphy","year":"2024","journal-title":"JACC CardioOncol."},{"key":"ref_3","first-page":"477","article-title":"Breast cancer statistics 2024","volume":"74","author":"Giaquinto","year":"2024","journal-title":"CA Cancer J. Clin."},{"key":"ref_4","first-page":"229","article-title":"Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","year":"2024","journal-title":"CA Cancer J. Clin."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"105128","DOI":"10.1016\/j.esmoop.2025.105128","article-title":"Cardiovascular toxicity of breast cancer treatments: From understanding to enhancing survivorship care","volume":"10","author":"Dauccia","year":"2025","journal-title":"ESMO Open"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1093\/eurheartj\/ehab674","article-title":"Defining cardiovascular toxicities of cancer therapies: An International Cardio-Oncology Society (IC-OS) consensus statement","volume":"43","author":"Herrmann","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2170","DOI":"10.1002\/ehf2.14373","article-title":"Early diagnostic value of high-sensitivity cardiac troponin T for cancer treatment-related cardiac dysfunction: A meta-analysis","volume":"10","author":"Lv","year":"2023","journal-title":"ESC Heart Fail."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1093\/annonc\/mdf170","article-title":"Myocardial injury revealed by plasma troponin I in breast cancer treated with high-dose chemotherapy","volume":"13","author":"Cardinale","year":"2002","journal-title":"Ann. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1981","DOI":"10.1161\/CIRCULATIONAHA.114.013777","article-title":"Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy","volume":"131","author":"Cardinale","year":"2015","journal-title":"Circulation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1056\/NEJMoa072100","article-title":"Coronary calcium as a predictor of coronary events in four racial or ethnic groups","volume":"358","author":"Detrano","year":"2008","journal-title":"N. Engl. J. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"729","DOI":"10.2147\/VHRM.S242636","article-title":"Subclinical Vascular Damage: Current Insights and Future Potential","volume":"17","author":"Mattioli","year":"2021","journal-title":"Vasc. 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Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1024","DOI":"10.1001\/jamaoncol.2021.1144","article-title":"Identification of Risk of Cardiovascular Disease by Automatic Quantification of Coronary Artery Calcifications on Radiotherapy Planning CT Scans in Patients with Breast Cancer","volume":"7","author":"Gal","year":"2021","journal-title":"JAMA Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1364","DOI":"10.1200\/JCO.2007.12.9791","article-title":"How to build and interpret a nomogram for cancer prognosis","volume":"26","author":"Iasonos","year":"2008","journal-title":"J. Clin. Oncol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e173","DOI":"10.1016\/S1470-2045(14)71116-7","article-title":"Nomograms in oncology: More than meets the eye","volume":"16","author":"Balachandran","year":"2015","journal-title":"Lancet Oncol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1016\/j.jcmg.2017.03.018","article-title":"Development and Validation of a Simple-to-Use Nomogram for Predicting 5-, 10-, and 15-Year Survival in Asymptomatic Adults Undergoing Coronary Artery Calcium Scoring","volume":"11","author":"Hartaigh","year":"2017","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1056\/NEJMoa035153","article-title":"The effect of dexrazoxane on myocardial injury in doxorubicin-treated children with acute lymphoblastic leukemia","volume":"351","author":"Lipshultz","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_18","first-page":"7","article-title":"A comparative assessment of coronary artery calcification on chest CT scans of patients referred to a cardio-oncology clinic","volume":"2","author":"Brann","year":"2016","journal-title":"Cardiooncology"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Lee, S.Y., Kim, T.H., Han, K., Shin, J.M., Kim, J.Y., Kim, D., and Park, C.H. (2021). Feasibility of Coronary Artery Calcium Scoring on Dual-Energy Chest Computed Tomography: A Prospective Comparison with Electrocardiogram-Gated Calcium Score Computed Tomography. J. Clin. Med., 10.","DOI":"10.3390\/jcm10040653"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.1007\/s00330-011-2112-8","article-title":"Unrequested information from routine diagnostic chest CT predicts future cardiovascular events","volume":"21","author":"Jacobs","year":"2011","journal-title":"Eur. Radiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.ijcard.2020.08.024","article-title":"Coronary and aortic calcification are associated with cardiovascular events on immune checkpoint inhibitor therapy","volume":"322","author":"Schiffer","year":"2020","journal-title":"Int. J. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1016\/j.atherosclerosis.2010.11.017","article-title":"Thoracic aortic calcification and coronary heart disease events: The multi-ethnic study of atherosclerosis (MESA)","volume":"215","author":"Budoff","year":"2011","journal-title":"Atherosclerosis"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2749","DOI":"10.1161\/01.CIR.0000130926.51766.CC","article-title":"Prognostic value of troponin I in cardiac risk stratification of cancer patients undergoing high-dose chemotherapy","volume":"109","author":"Cardinale","year":"2004","journal-title":"Circulation"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1016\/j.amjcard.2011.01.006","article-title":"Early detection and prediction of cardio-toxicity in chemotherapy-treated patients","volume":"107","author":"Sawaya","year":"2011","journal-title":"Am. J. Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2835","DOI":"10.1001\/jama.1986.03380200073024","article-title":"Incidence of coronary heart disease and lipoprotein cholesterol levels. The Framingham Study","volume":"256","author":"Castelli","year":"1986","journal-title":"JAMA"},{"key":"ref_26","first-page":"617","article-title":"Trastuzumab Emtansine for Residual Invasive HER2-Positive Breast Cancer","volume":"380","author":"Huang","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.jaccao.2025.05.006","article-title":"Cardiac Safety of Reduced Cardiotoxicity Surveillance During HER2-Targeted Therapy","volume":"7","author":"Yu","year":"2025","journal-title":"JACC CardioOncol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1093\/jnci\/djs317","article-title":"Risk of heart failure in breast cancer patients after anthracycline and trastuzumab treatment: A retrospective cohort study","volume":"104","author":"Bowles","year":"2012","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1038\/nm0502-459","article-title":"ErbB2 is essential in the prevention of dilated cardiomyopathy","volume":"8","author":"Crone","year":"2002","journal-title":"Nat. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1007\/s00395-016-0576-z","article-title":"ErbB2 signaling at the crossing between heart failure and cancer","volume":"111","author":"Vermeulen","year":"2016","journal-title":"Basic Res. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"954","DOI":"10.1161\/CIRCULATIONAHA.107.690487","article-title":"Role of neuregulin-1\/ErbB signaling in cardiovascular physiology and disease: Implications for therapy of heart failure","volume":"116","author":"Lemmens","year":"2007","journal-title":"Circulation"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1945","DOI":"10.1002\/ejhf.1920","article-title":"Baseline cardiovascular risk assessment in cancer patients scheduled to receive cardiotoxic cancer therapies: A position statement and new risk assessment tools from the Cardio-Oncology Study Group of the Heart Failure Association of the European Society of Cardiology in collaboration with the International Cardio-Oncology Society","volume":"22","author":"Lyon","year":"2020","journal-title":"Eur. J. Heart Fail."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1200\/JCO.2016.70.5400","article-title":"Prevention and Monitoring of Cardiac Dysfunction in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline","volume":"35","author":"Armenian","year":"2016","journal-title":"J. Clin. Oncol."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"S\u0142awi\u0144ski, G., Hawryszko, M., Li\u017cewska-Springer, A., Nabia\u0142ek-Trojanowska, I., and Lewicka, E. (2023). Global Longitudinal Strain in Cardio-Oncology: A Review. 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