MEDiastinal Irradiation and CArdio-Toxic Effects (MEDICATE): Exploring the Relationship between Cardiac Irradiation and High Sensitivity Troponins
| Autor: | Hisham Dokainish, Graeme Fraser, S. Voruganti, James R. Wright, Anand Swaminath, Gregory R. Pond, Peter A. Kavsak, Jonathan Sussman, Gordon Okawara, Stephen M. Sagar, Elysia Donovan, Darryl P. Leong, Sukhbinder Dhesy-Thind |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Heart disease Heart Diseases Cardiac Volume medicine.medical_treatment 030218 nuclear medicine & medical imaging 03 medical and health sciences Young Adult 0302 clinical medicine Internal medicine Medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies Radiation Injuries Aged Cardiotoxicity Ejection fraction biology business.industry Late effect Heart Radiotherapy Dosage Middle Aged medicine.disease Troponin Radiation therapy medicine.anatomical_structure Oncology Ventricle 030220 oncology & carcinogenesis cardiovascular system biology.protein Cardiology Female medicine.symptom Radiotherapy Conformal business |
| Zdroj: | Clinical oncology (Royal College of Radiologists (Great Britain)). 31(7) |
| ISSN: | 1433-2981 |
| Popis: | Aims Radiation-induced heart disease is a late effect of cardiac irradiation and has been shown in patients with lymphoma and thoracic cancers. There is no established measurement tool to detect acute cardiac damage. However, high sensitivity troponin I and T (HsTnI and HsTnT) and echocardiograms have shown promise in some studies. A pilot trial was conducted to characterise whether these instruments may detect subclinical radiotherapy-induced cardiac damage. Materials and methods Eligible patients received high cardiac doses defined by either at least 30 Gy to 5% of cardiac volume or a mean dose of 4 Gy. HsTnI and HsTnT were measured before radiotherapy and after 2 and 4 weeks of radiotherapy; three-dimensional echocardiograms were completed before and 1 year after radiotherapy. Results Of 19 patients, the median ‘mean left ventricular dose’ was 3.1 Gy and the ‘mean cardiac dose’ was 8.6 Gy. Significant positive associations between HsTnI and HsTnT were observed at all time points, but there was no significant association with cardiac dose. The mean left ventricular dose and the maximum left ventricular dose were, however, associated with a decrease in ejection fraction (P = 0.054, 0.043) as well as an increase in left ventricular strain (P = 0.058). Conclusion This study suggests that HsTnI and HsTnT are intimately related, but detection of acute cardiac damage was not shown, potentially due to limitations of these markers or low radiotherapy doses using conformal techniques. Our results also suggest subacute damage at 1 year may depend on the dose to the left ventricle. Further studies are needed, as identification of early damage could facilitate the ability to closely monitor and intervene in patients at risk for radiation-induced heart disease. |
| Databáze: | OpenAIRE |
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