University of New South Wales, Sydney, NSW, Australia.
University of New South Wales, Sydney, NSW, Australia; Ingham Institute of Applied Medical Research, Liverpool Hospital Cancer Therapy Centre, Australia.
Int J Cardiol. 2017 Sep 15;243:204-208. doi: 10.1016/j.ijcard.2017.05.007. Epub 2017 May 5.
To investigate alterations in left ventricular (LV) diastolic function using traditional and novel echocardiographic parameters, following radiation therapy (RT) in breast cancer patients in the acute setting.
40 chemotherapy-naïve women with left-sided breast cancer undergoing RT were prospectively recruited. A comprehensive transthoracic echocardiogram (TTE) was performed at baseline, during RT and 6weeks post-RT. Traditional echocardiographic diastolic parameters and diastolic strain rate were measured and analysed. The relationship between alterations in diastolic parameters, changes in global longitudinal systolic strain (GLS) and radiation dose were investigated.
Traditional diastolic parameters remained largely unchanged; however diastolic strain parameters, E-Sr and A-Sr were significantly reduced 6weeks post-RT [Longitudinal E-Sr (s) 1.47+/-0.32 vs 1.29+/-0.27*; Longitudinal A-Sr (s) 1.19+/-0.31 vs 1.03+/-0.24*; *p<0.05 vs baseline]. When patients were divided by a reduction ≥10% versus <10% in GLS post-RT, a greater reduction in both traditional diastolic and diastolic strain parameters was observed in the group with >10% reduction in systolic function as evaluated by GLS. When patients were divided by mean v30 dose, a greater % change in E-Sr was noted in those receiving more than mean V30 dose.
Diastolic dysfunction was only evident acutely, post-RT with the use of newer methods like strain analysis. A significant reduction in diastolic function was seen in the patient subgroup with ≥10% reduction in systolic function, enhancing the notion of diastolic function as a potential indicator for systolic dysfunction. Future longitudinal studies are required to determine the specific prognostic value of these observations.
在乳腺癌患者接受放射治疗（RT）的急性期，使用传统和新型超声心动图参数研究左心室（LV）舒张功能的变化。
前瞻性招募了 40 名接受 RT 的左侧乳腺癌且未接受化疗的女性患者。在基线、RT 期间和 RT 后 6 周进行全面的经胸超声心动图（TTE）检查。测量和分析传统超声心动图舒张参数和舒张应变率。研究舒张参数变化与整体纵向收缩应变（GLS）和辐射剂量之间的关系。
传统舒张参数基本保持不变；然而，6 周后舒张应变参数 E-Sr 和 A-Sr 明显降低[纵向 E-Sr（s）1.47+/-0.32 比 1.29+/-0.27*；纵向 A-Sr（s）1.19+/-0.31 比 1.03+/-0.24*；*p<0.05 比基线]。当根据 RT 后 GLS 降低≥10%与<10%将患者分为两组时，与 GLS 评估的收缩功能降低≥10%的组相比，观察到传统舒张参数和舒张应变参数的降低更大。当根据平均 v30 剂量将患者分为两组时，接受高于平均 v30 剂量的患者 E-Sr 的变化百分比更大。
只有在使用应变分析等新方法时，RT 后才会出现舒张功能障碍。在收缩功能降低≥10%的患者亚组中观察到舒张功能显著降低，这增强了舒张功能作为收缩功能障碍潜在指标的概念。需要进行未来的纵向研究来确定这些观察结果的具体预后价值。
