Chen Lu, Ta Shengjun, Wu Weihua, Wang Changlu, Zhang Qin
Department of Ultrasound, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
Department of Ultrasound, Yan'an People's Hospital, Yan'an, China.
Ultrasound Med Biol. 2019 Jan;45(1):98-107. doi: 10.1016/j.ultrasmedbio.2018.09.012. Epub 2018 Oct 23.
Radiotherapy (RT) is potentially related to cardiotoxicity, which may partially offset the benefits of cancer treatment. We sought to evaluate subclinical myocardial dysfunction using speckle tracking echocardiography after RT and to explore the associations between early cardiac effects and adverse outcomes in patients with non-small cell lung cancer (NSCLC). In total, 112 patients with stage III NSCLC who were scheduled to receive RT were prospectively recruited. A reduction in global longitudinal strain (GLS) was observed immediately after RT and at 6 mo after RT (6 m-RT). In multivariable analysis, the percentage change in GLS from baseline to 6 mo (ΔGLS%) (hazard ratio = 1.202, 95% confidence interval: 1.095-1.320, p < 0.001) was an independent predictor of all-cause mortality. Based on receiver operating characteristic curve analysis, ΔGLS% ≥13.65% had 65.9% sensitivity and 85.2% specificity for predicting mortality in NSCLC patients (area under the curve = 0.784, 95% confidence interval: 0.692-0.876, p < 0.001). These findings should encourage physicians to perform echocardiography early after RT.
放射治疗（RT）可能与心脏毒性有关，这可能会部分抵消癌症治疗的益处。我们试图在放疗后使用斑点追踪超声心动图评估亚临床心肌功能障碍，并探讨非小细胞肺癌（NSCLC）患者早期心脏效应与不良结局之间的关联。总共前瞻性招募了112例计划接受放疗的III期NSCLC患者。放疗后即刻和放疗后6个月（6m-RT）观察到整体纵向应变（GLS）降低。在多变量分析中，从基线到6个月GLS的百分比变化（ΔGLS%）（风险比=1.202，95%置信区间：1.095-1.320，p<0.001）是全因死亡率的独立预测因素。基于受试者工作特征曲线分析，ΔGLS%≥13.65%对预测NSCLC患者死亡率具有65.9%的敏感性和85.2%的特异性（曲线下面积=0.784，95%置信区间：0.692-0.876，p<0.001）。这些发现应促使医生在放疗后早期进行超声心动图检查。
