Martinez Hugo R, Salloum Ralph, Wright Erin, Bueche Lauren, Khoury Philip R, Tretter Justin T, Ryan Thomas D
Division of Cardiology, Department of Pediatrics, University of Cincinnati College of Medicine, and Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2003, Cincinnati, OH, 45229, USA.
Present address: Division of Pediatric Cardiology, Heart Institute, Le Bonheur Children's Hospital, University of Tennessee Health and Science Center, Memphis, TN, USA.
Cardiooncology. 2021 Feb 2;7(1):5. doi: 10.1186/s40959-021-00093-z.
Craniospinal irradiation (CSI) is part of the treatment of central nervous system (CNS) tumors and is associated with cardiovascular disease in adults. Global myocardial strain analysis including longitudinal peak systolic strain (GLS), circumferential peak systolic strain (GCS), and radial peak systolic strain (GRS) can reveal subclinical cardiac dysfunction.
Retrospective, single-center study in patients managed with CSI vs. age-matched controls. Clinical data and echocardiography, including myocardial strain analysis, were collected at early (< 12 months) and late (≥ 12 months) time points after completion of CSI.
Echocardiograms were available at 20 early and 34 late time points. Patients at the late time point were older (21.7 ± 10.4 vs. 13.3 ± 9.6 years) and further out from CSI (13.1 ± 8.8 vs. 0.2 ± 0.3 years). Standard echocardiographic parameters were normal for both groups. For early, CSI vs. control: GLS was - 16.8 ± 3.6% vs. -21.3 ± 4.0% (p = 0.0002), GCS was - 22.5 ± 5.2% vs. -21.3 ± 3.4% (p = 0.28), and GRS was 21.8 ± 11.0% vs. 26.9 ± 7.7% (p = 0.07). For late, CSI vs. control: GLS was - 16.2 ± 5.4% vs. -21.6 ± 3.7% (p < 0.0001), GCS was - 20.9 ± 6.8% vs. -21.9 ± 3.5% (p = 0.42), and GRS was 22.5 ± 10.0% vs. 27.3 ± 8.3% (p = 0.03). Radiation type (proton vs. photon), and radiation dose (< 30 Gy vs. ≥ 30 Gy) did not impact any parameter, although numbers were small.
Subclinical cardiac systolic dysfunction by GLS is present both early and late after CSI. These results argue for future studies to determine baseline cardiovascular status and the need for early initiation of longitudinal follow-up post CSI.
颅脊髓照射（CSI）是中枢神经系统（CNS）肿瘤治疗的一部分，与成人心血管疾病相关。包括纵向峰值收缩期应变（GLS）、圆周峰值收缩期应变（GCS）和径向峰值收缩期应变（GRS）在内的整体心肌应变分析可揭示亚临床心脏功能障碍。
对接受CSI治疗的患者与年龄匹配的对照组进行回顾性单中心研究。在CSI完成后的早期（<12个月）和晚期（≥12个月）时间点收集临床数据和超声心动图，包括心肌应变分析。
在20个早期和34个晚期时间点可获得超声心动图。晚期时间点的患者年龄更大（21.7±10.4岁对13.3±9.6岁），距离CSI完成的时间更远（13.1±8.8年对0.2±0.3年）。两组的标准超声心动图参数均正常。早期，CSI组与对照组相比：GLS为-16.8±3.6%对-21.3±4.0%（p = 0.0002），GCS为-22.5±5.2%对-21.3±3.4%（p = 0.28），GRS为21.8±11.0%对26.9±7.7%（p = 0.07）。晚期，CSI组与对照组相比：GLS为-16.2±5.4%对-21.6±3.7%（p < 0.0001），GCS为-20.9±6.8%对-21.9±3.5%（p = 0.42），GRS为22.5±10.0%对27.3±8.3%（p = 0.03）。尽管样本数量较少，但放疗类型（质子放疗与光子放疗）和放疗剂量（<30 Gy对≥30 Gy）对任何参数均无影响。
CSI后早期和晚期均存在由GLS检测到的亚临床心脏收缩功能障碍。这些结果表明未来需要进行研究以确定基线心血管状态以及CSI后早期开始长期随访的必要性。
