Development and Validation of a Thoracic Aortic Calcification-Based Nomogram for Early Myocardial Injury in Breast Cancer Patients

Abstract

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 > 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 < 0.001). This thoracic aortic calcification-based nomogram may support the identification of patients at high risk of early myocardial injury after anticancer therapy.