基于蒽环类化疗药物的治疗对弥漫性大B细胞淋巴瘤患者心血管风险和益处进行平衡是一个重要的临床问题。我们旨在评估术前冠状动脉钙化评分(CACS)是否能够分层评估接受基于蒽环类化疗药物的弥漫性大B细胞淋巴瘤患者患癌症治疗相关心脏功能障碍(CTRCD)和重大不良心血管事件(MACEs)的风险。 回顾性收纳了四家医院的弥漫性大B细胞淋巴瘤患者。使用人工智能-CACS软件在非门控胸部计算机断层扫描图像上自动计算CACS，并将其分为三类(0、1-100和>100)。采用logistic回归和Fine-Gray竞争风险回归模型评估CACS与CTRCD和MACEs之间的关系。进行Nelson-Aalen累积风险曲线来评估MACEs的累积发生率。共招募了1468名患者(785男，683女；100%亚洲人)，其中362名患者出现CTRCD，185名患者出现MACEs。与CACS为0(n=826)相比，CACS在1至100(n=356)和>100 (n=286)之间的CTRCD患病风险逐渐增加(比值比分别为2.587和5.239)。 CACS与MACEs相关（1-100与0比较:亚分布危险比3.726；>100与0比较:亚分布危险比为7.858；所有P<0.001）。在3年和5年，CACS为0、1-100和>100的患者的竞争性风险调整后的MACEs率分别为1.21%、8.43%和11.19%，3.27%、16.01%和31.12%。在治疗前从胸部计算机断层扫描图像自动获得的CACS有助于识别CTRCD和MACEs的高风险患者，并指导临床医生在接受基于蒽环类化疗药物的弥漫性大B细胞淋巴瘤患者实施心血管保护策略。

Balancing the cardiovascular risk and benefit of anthracycline-based chemotherapy in patients with diffuse large B-cell lymphoma is an important clinical issue. We aimed to evaluate whether the pretreatment coronary artery calcium score (CACS) can stratify the risk of cancer therapy-related cardiac dysfunction (CTRCD) and major adverse cardiovascular events (MACEs) in patients with diffuse large B-cell lymphoma receiving anthracycline-based chemotherapy.The patients with diffuse large B-cell lymphoma from 4 hospitals were retrospectively enrolled. The CACS was automatically calculated on nongated chest computed tomography before treatment using artificial intelligence-CACS software and divided into 3 categories (0, 1-100, and >100). The associations between the CACS and CTRCD and between the CACS and MACEs were assessed by logistic regression and Fine-Gray competing-risk regression model. Nelson-Aalen cumulative risk curve was performed to assess the cumulative incidence of MACEs.A total of 1468 patients (785 men and 683 women; 100% Asian) were enrolled, and 362 and 185 patients developed CTRCD and MACEs, respectively. Compared with a CACS of 0 (n=826), there was stepwise higher odds of CTRCD with a CACS between 1 and 100 (n=356; odds ratio, 2.587) and a CACS >100 (n=286; odds ratio, 5.239). The CACS was associated with MACEs (1-100 versus 0: subdistribution hazard ratio 3.726; >100 versus 0: subdistribution hazard ratio 7.858; all P<0.001). Competing risk-adjusted MACEs rates for patients with a CACS of 0, 1 to 100, and >100 were 1.21%, 8.43%, and 11.19%, respectively, at 3 years, and 3.27%, 16.01%, 31.12%, respectively, at 5 years.The automatic CACS derived from chest computed tomography before treatment was helpful to identify high-risk patients of CTRCD and MACE and guide clinicians to implement cardiovascular protection strategies in patients with diffuse large B-cell lymphoma who received anthracycline-based chemotherapy.