Tuohinen Suvi Sirkku, Skyttä Tanja, Huhtala Heini, Poutanen Tuija, Virtanen Vesa, Kellokumpu-Lehtinen Pirkko-Liisa, Raatikainen Pekka
Heart and Lung Center, Helsinki University Central Hospital, Helsinki University, Helsinki, Finland.
Heart Hospital, Tampere University Hospital, University of Tampere, Tampere, Finland.
JACC CardioOncol. 2021 Jun 15;3(2):277-289. doi: 10.1016/j.jaccao.2021.03.005. eCollection 2021 Jun.
Radiation therapy (RT) results in myocardial changes consisting of diffuse fibrosis, which may result in changes in diastolic function.
The aim of this study was to explore RT-associated changes in left ventricular (LV) diastolic function.
Sixty chemotherapy-naive patients with left-sided, early-stage breast cancer were studied with speckle tracking echocardiography at 3 time points: prior to, immediately after, and 3 years after RT. Global and regional early diastolic strain rate (SRe) were quantified, as were parameters of systolic function.
Regional changes in SRe, particularly the apical and anteroseptal segments, were observed over time and were more evident than global changes. The apical SRe declined from a median of 1.24 (interquartile range: 1.01 to 1.39) s at baseline to 1.02 (interquartile range: 0.79 to 1.15) s at 3 years of follow-up (p < 0.001). This decline was associated with the left ventricular maximal radiation dose (β = 0.36, p = 0.007). The global SRe was <1.00 s (SRe) in 11 (18.3%) patients at baseline, 21 (35%) patients (p = 0.013) post-RT, and 17 (28.3%) patients (p = 0.051) at 3 years. SRe post-RT was independently associated with baseline cardiac abnormalities (odds ratio: 0.26; 95% confidence interval: 0.08 to 0.84; p = 0.025); SRe at 3 years of follow-up was associated with the baseline Charlson comorbidity index (odds ratio: 2.36; 95% confidence interval: 1.17 to 4.77; p = 0.017). Diastolic function abnormalities were evident even in patients with preserved global longitudinal strain at 3 years.
RT resulted in changes in the SRe in the apical and anteroseptal segments over 3 years of follow-up. Changes in SRe apical segments were present even in patients with preserved systolic function and were independently associated with RT dose and cardiovascular comorbidities.
放射治疗（RT）会导致心肌发生包括弥漫性纤维化在内的变化，这可能会引起舒张功能的改变。
本研究旨在探讨与放射治疗相关的左心室（LV）舒张功能变化。
对60例未经化疗的左侧早期乳腺癌患者在3个时间点进行斑点追踪超声心动图检查：放疗前、放疗后即刻以及放疗后3年。对整体和局部早期舒张应变率（SRe）进行量化，同时也对收缩功能参数进行量化。
随着时间推移观察到SRe的局部变化，尤其是心尖段和前间隔段，且比整体变化更明显。心尖SRe从基线时的中位数1.24（四分位间距：1.01至1.39）s下降至随访3年时的1.02（四分位间距：0.79至1.15）s（p < 0.001）。这种下降与左心室最大放射剂量相关（β = 0.36，p = 0.007）。基线时11例（18.3%）患者的整体SRe < 1.00 s，放疗后21例（35%）患者（p = 0.013），3年时17例（28.3%）患者（p = 0.051）。放疗后SRe与基线心脏异常独立相关（比值比：0.26；95%置信区间：0.08至0.84；p = 0.025）；随访3年时的SRe与基线查尔森合并症指数相关（比值比：2.36；95%置信区间：1.17至4.77；p = 0.017）。即使在3年时整体纵向应变保留的患者中，舒张功能异常也很明显。
在3年的随访中，放射治疗导致心尖段和前间隔段的SRe发生变化。即使在收缩功能保留的患者中，心尖段SRe也有变化，且与放射剂量和心血管合并症独立相关。
