Subclinical Left Ventricular Dysfunction Detected by Speckle-Tracking Echocardiography in Breast Cancer Patients Treated With Radiation Therapy: A Six-Month Follow-Up Analysis (MEDIRAD EARLY‐HEART study)

Frontiers in Oncology

Manuela Fiuza²  Susana Constantino Rosa Santos²  Ferran Guedea³  Arantxa Eraso³  Kai Borm⁴  Stephanie Combs⁴  Anne Crijns⁵  Daan Spoor⁵  Pim van der Harst⁵  Hans Langendijk⁵  Elie Mousseaux⁶  Umit Gencer⁶  Guy Frija⁶  Sophie Jacob⁷  Médéa Locquet⁷  Elisabeth Cardis⁹ 

[1] Barcelona Institute of Global Health (ISGlobal), Barcelona, Spain;Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal;Department of Radiation Oncology, Institut Catala Oncologia (ICO), Girona, Spain;Department of Radiation Oncology, Technical University of Munich (TUM-MED), Munich, Germany;Department of Radiation Oncology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands;Department of Radiology, Paris-Descartes University and INSERM970, Hôpital Européen Georges Pompidou, Paris, France;Laboratory of Epidemiology, Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, France;Pompeu Fabra University, Barcelona, Spain;Spanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain;

关键词: MEDIRAD;    breast cancer;    radiotherapy;    cardiac dysfunction;    dosimetry;    strain imaging;   

DOI  :  10.3389/fonc.2022.883679

来源: DOAJ

【 摘 要 】

BackgroundIn the case of breast cancer (BC), radiotherapy (RT) helps reduce locoregional recurrence and BC-related deaths but can lead to cardiotoxicity, resulting in an increased risk of long-term major cardiovascular events. It is therefore of primary importance to early detect subclinical left ventricular (LV) dysfunction in BC patients after RT and to determine the dose–response relationships between cardiac doses and these events.MethodsWithin the frame of the MEDIRAD European project (2017–2022), the prospective multicenter EARLY‐HEART study (ClinicalTrials.gov Identifier: NCT03297346) included chemotherapy naïve BC women aged 40–75 years and treated with lumpectomy and adjuvant RT. Myocardial strain analysis was provided using speckle‐tracking echocardiography performed at baseline and 6 months following RT. A global longitudinal strain (GLS) reduction >15% between baseline and follow-up was defined as a GLS-based subclinical LV dysfunction. Individual patient dose distributions were obtained using multi-atlas-based auto-segmentation of the heart. Dose-volume parameters were studied for the whole heart (WH) and left ventricle (LV).ResultsThe sample included 186 BC women (57.5 ± 7.9 years, 64% left-sided BC). GLS-based subclinical LV dysfunction was observed in 22 patients (14.4%). These patients had significantly higher cardiac exposure regarding WH and LV doses compared to patients without LV dysfunction (for mean WH dose: 2.66 ± 1.75 Gy versus 1.64 ± 0.96 Gy, p = 0.01). A significantly increased risk of subclinical LV dysfunction was observed with the increase in the dose received to the WH [ORs from 1.13 (V5) to 1.74 (Dmean); p <0.01] and to the LV [ORs from 1.10 (V5) to 1.46 (Dmean); p <0.01]. Based on ROC analysis, the LV-V5 parameter may be the best predictor of the short-term onset of subclinical LV dysfunction.ConclusionThese results highlighted that all cardiac doses were strongly associated with the occurrence of subclinical LV dysfunction arising 6 months after BC RT. Whether measurements of GLS at baseline and 6 months after RT combined with cardiac doses can early predict efficiently subclinical events occurring 24 months after RT remains to be investigated.

【 授权许可】

Unknown