应变率成像检测乳腺癌患者心脏功能的急性辐射效应。
Acute radiation effects on cardiac function detected by strain rate imaging in breast cancer patients.
机构信息
Department of Radiotherapy, University Hospital Gasthuisberg, Leuven, Belgium.
出版信息
Int J Radiat Oncol Biol Phys. 2011 Apr 1;79(5):1444-51. doi: 10.1016/j.ijrobp.2010.01.004. Epub 2010 Jun 3.
PURPOSE
To investigate the occurrence of early radiation-induced changes in regional cardiac function using strain rate imaging (SRI) by tissue Doppler echocardiography.
METHODS AND MATERIALS
We included 20 left-sided and 10 right-sided breast cancer patients receiving radiotherapy (RT) to the breast or chest wall. Standard echocardiography and SRI were performed before RT (baseline), immediately after RT (post-RT), and at 2 months follow-up (FUP) after RT. Regional strain (S) and strain rate (SR) values were obtained from all 18 left ventricular (LV) segments. Data were compared to the regional radiation dose.
RESULTS
A reduction in S was observed post-RT and at FUP in left-sided patients (S(post-RT): -17.6 ± 1.5%, and S(FUP): -17.4 ± 2.3%, vs. S(baseline): -19.5 ± 2.1%, p < 0.001) but not in right-sided patients. Within the left-sided patient group, S and SR were significantly reduced after RT in apical LV segments (S(post-RT): -15.3 ± 2.5%, and S(FUP): -14.3 ± 3.7%, vs. S(baseline): -19.3 ± 3.0%, p < 0.01; and SR(post-RT): -1.06 ± 0.15 s(-1), and SR(FUP): -1.16 ± 0.28 s(-1), vs. SR(baseline): -1.29 ± 0.27 s(-1), p = 0.01), but not in mid- or basal segments. Furthermore, we observed that segments exposed to more than 3 Gy showed a significant decrease in S after RT (S(post-RT): -16.1 ± 1.6%, and S(FUP): -15.8 ± 3.4%, vs. S(baseline): -18.9 ± 2.6%, p < 0.001). This could not be observed in segments receiving less than 3 Gy.
CONCLUSIONS
SRI shows a dose-related regional decrease in myocardial function after RT. It might be a useful tool in the evaluation of modern RT techniques, with respect to cardiac toxicity.
目的
使用组织多普勒超声心动图的应变率成像（SRI）来研究早期放射性诱导的区域性心脏功能变化的发生。
方法和材料
我们纳入了 20 例左侧和 10 例右侧乳腺癌患者，他们接受了乳房或胸壁的放射治疗（RT）。在 RT 前（基线）、RT 后即刻（RT 后）和 RT 后 2 个月随访（FUP）进行标准超声心动图和 SRI。从所有 18 个左心室（LV）节段获得局部应变（S）和应变率（SR）值。将数据与局部辐射剂量进行比较。
结果
左侧患者在 RT 后和 FUP 时观察到 S 降低（S(post-RT)：-17.6 ± 1.5%，S(FUP)：-17.4 ± 2.3%，vs. S(baseline)：-19.5 ± 2.1%，p < 0.001），但右侧患者没有。在左侧患者组中，在 LV 心尖段的 S 和 SR 在 RT 后显著降低（S(post-RT)：-15.3 ± 2.5%，S(FUP)：-14.3 ± 3.7%，vs. S(baseline)：-19.3 ± 3.0%，p < 0.01；和 SR(post-RT)：-1.06 ± 0.15 s(-1)，SR(FUP)：-1.16 ± 0.28 s(-1)，vs. SR(baseline)：-1.29 ± 0.27 s(-1)，p = 0.01），但在中段或基底段没有。此外，我们观察到暴露于 3 Gy 以上的节段在 RT 后 S 明显下降（S(post-RT)：-16.1 ± 1.6%，S(FUP)：-15.8 ± 3.4%，vs. S(baseline)：-18.9 ± 2.6%，p < 0.001）。在接受小于 3 Gy 的节段中没有观察到这种情况。
结论
SRI 显示 RT 后心肌功能呈剂量依赖性区域性下降。它可能是评估现代 RT 技术心脏毒性的有用工具。
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