3-Year Follow-Up of Radiation-Associated Changes in Diastolic Function by Speckle Tracking Echocardiography.

Autor: Tuohinen SS; Heart and Lung Center, Helsinki University Central Hospital, Helsinki University, Helsinki, Finland.; Heart Hospital, Tampere University Hospital, University of Tampere, Tampere, Finland., Skyttä T; Department of Oncology, Tampere University Hospital, Tampere, Finland.; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland., Huhtala H; Faculty of Social Sciences, Tampere University, Tampere, Finland., Poutanen T; Center for Child Health Research, Tampere, Finland.; Department of Pediatrics, Faculty of Medicine and Heath Technology, Tampere University Hospital and Tampere University, Tampere, Finland., Virtanen V; Heart Hospital, Tampere University Hospital, University of Tampere, Tampere, Finland.; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland., Kellokumpu-Lehtinen PL; Department of Oncology, Tampere University Hospital, Tampere, Finland.; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland., Raatikainen P; Heart and Lung Center, Helsinki University Central Hospital, Helsinki University, Helsinki, Finland.
Jazyk: angličtina
Zdroj: JACC. CardioOncology [JACC CardioOncol] 2021 Jun 15; Vol. 3 (2), pp. 277-289. Date of Electronic Publication: 2021 Jun 15 (Print Publication: 2021).
DOI: 10.1016/j.jaccao.2021.03.005
Abstrakt: Background: Radiation therapy (RT) results in myocardial changes consisting of diffuse fibrosis, which may result in changes in diastolic function.
Objectives: The aim of this study was to explore RT-associated changes in left ventricular (LV) diastolic function.
Methods: Sixty chemotherapy-naive patients with left-sided, early-stage breast cancer were studied with speckle tracking echocardiography at 3 time points: prior to, immediately after, and 3 years after RT. Global and regional early diastolic strain rate (SRe) were quantified, as were parameters of systolic function.
Results: Regional changes in SRe, particularly the apical and anteroseptal segments, were observed over time and were more evident than global changes. The apical SRe declined from a median of 1.24 (interquartile range: 1.01 to 1.39) s -1 at baseline to 1.02 (interquartile range: 0.79 to 1.15) s -1 at 3 years of follow-up (p < 0.001). This decline was associated with the left ventricular maximal radiation dose (β = 0.36, p = 0.007). The global SRe was <1.00 s -1 (SRe dep ) in 11 (18.3%) patients at baseline, 21 (35%) patients (p = 0.013) post-RT, and 17 (28.3%) patients (p = 0.051) at 3 years. SRe dep post-RT was independently associated with baseline cardiac abnormalities (odds ratio: 0.26; 95% confidence interval: 0.08 to 0.84; p = 0.025); SRe dep at 3 years of follow-up was associated with the baseline Charlson comorbidity index (odds ratio: 2.36; 95% confidence interval: 1.17 to 4.77; p = 0.017). Diastolic function abnormalities were evident even in patients with preserved global longitudinal strain at 3 years.
Conclusions: RT resulted in changes in the SRe in the apical and anteroseptal segments over 3 years of follow-up. Changes in SRe apical segments were present even in patients with preserved systolic function and were independently associated with RT dose and cardiovascular comorbidities.
Competing Interests: This study has received funding from nonprofit trusts: Paavo and Eila Salonen Legacy, the Finnish Foundation for Cardiovascular Research, and the Finnish Society of Oncology. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
(© 2021 The Authors.)
Databáze: MEDLINE
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