二维斑点追踪超声心动图在评估放射性心脏损伤中的应用
Two-dimensional speckle tracking echocardiography in evaluating radiation-induced heart damage.
作者信息
Li Tingcui, Zhuang Hongqing, Wang Yuxia, Li Jun, Zhu Dan, Cui Ming
机构信息
Department of Cardiology, Peking University Third Hospital, Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Sciences, Ministry of Education, Beijing, China.
Department of Radiation Oncology, Peking University Third Hospital, Beijing, China.
出版信息
Asia Pac J Oncol Nurs. 2021 Dec 25;9(2):119-124. doi: 10.1016/j.apjon.2021.12.008. eCollection 2022 Feb.
OBJECTIVE
Radiation-induced heart damage (RIHD) in malignant tumor patients with thoracic radiotherapy has been well documented. However, there is no study on the cardiac toxicity of stereotactic body radiotherapy (SBRT) based on two-dimensional speckle tracking echocardiography (2D STE).
METHODS
In a prospective cohort trial, 48 patients with malignant tumor (including patients with lung cancer, pulmonary metastases and other tumor) were assigned to receive thoracic SBRT. Circulating biomarkers, electrocardiogram (ECG), echocardiography, and 2D STE were performed prior to and within two months after thoracic radiotherapy. The primary outcome of the trial was a decrease in global longitudinal strain (GLS) ≥ 10%. The secondary outcomes were major adverse cardiovascular events (MACE). Analysis were conducted using paired sample t-test, Wilcoxon signed rank test and Chi square test.
RESULTS
The morbidity of RIHD is 44% within 2 months after SBRT in malignant tumor patients. Compared with pre-RT, a significant decrease in GLS was observed post-RT (-17.98 ± 3.54% vs. -16.92 ± 3.41%; = 0.008), without any significant change in left ventricular ejection fraction (LVEF) (68.54 ± 6.06 vs. 69.63 ± 4.45; = 0.234), left ventricular mass (LVM) ( = 0.342), ECG parameters, creatine kinase ( = 0.074), cardiac troponin T ( = 0.829) or N-terminal pro-B-type natriuretic peptide ( = 0.453) at during the post-RT period. There was no evidence that RIHD was correlated with age ( = 1.000), mean heart dose ( = 0.602), BED ( = 0.234), EQD2/2 ( = 0.615), V5 ( = 0.506), V10 ( = 0.578), V20 ( = 0.670) and V30 ( = 0.741). Subgroup analysis showed, there is still a significant decline of GLS (-18.30 ± 3.79% vs. -17.11 ± 3.58%; = 0.018) in patients without anthracycline treatment. And the decrease of GLS (-19.14 ± 2.42% vs. -16.85 ± 2.46%; = 0.004) was more significantly post-RT in anthracycline treatment group. MACE were found in one patient over a period of two months after SBRT.
CONCLUSIONS
By using strain analysis subclinical cardiac dysfunction was found to be evident early after SBRT, despite unchanged conventional indices such as LVEF, ECG parameters or circulating biomarkers. And the decrease of GLS is still existed after the effect of anthracycline was removed.
TRIAL REGISTRATION
ClinicalTrials.gov, registration number: NCT04443400.
目的
恶性肿瘤患者胸部放疗所致放射性心脏损伤（RIHD）已有充分记录。然而，基于二维斑点追踪超声心动图（2D-STE）的立体定向体部放疗（SBRT）的心脏毒性尚无研究。
方法
在一项前瞻性队列试验中，48例恶性肿瘤患者（包括肺癌、肺转移瘤及其他肿瘤患者）接受胸部SBRT。在胸部放疗前及放疗后2个月内进行循环生物标志物、心电图（ECG）、超声心动图及2D-STE检查。试验的主要结局是整体纵向应变（GLS）降低≥10%。次要结局是主要不良心血管事件（MACE）。采用配对样本t检验、Wilcoxon符号秩检验和卡方检验进行分析。
结果
恶性肿瘤患者SBRT后2个月内RIHD的发病率为44%。与放疗前相比，放疗后GLS显著降低（-17.98±3.54%对-16.92±3.41%；P=0.008），而左心室射血分数（LVEF）（68.54±6.06对69.63±4.45；P=0.234）、左心室质量（LVM）（P=0.342）、ECG参数、肌酸激酶（P=0.074）、心肌肌钙蛋白T（P=0.829）或N末端B型脑钠肽前体（P=0.453）在放疗后期间无显著变化。没有证据表明RIHD与年龄（P=1.000）、平均心脏剂量（P=0.602）、生物等效剂量（BED）（P=0.234）、等效均匀剂量2/2（EQD2/2）（P=0.615）、V5（P=0.506）V1（P=0.578）、V20（P=0.670）和V30（P=0.741）相关。亚组分析显示，未接受蒽环类药物治疗的患者GLS仍显著下降（-（18.30±3.79%对-17.11±3.58%；P=0.018）。在蒽环类药物治疗组中，放疗后GLS的下降（-19.14±2.42%对-16.85±2.46%；P=0.004）更显著。SBRT后2个月内有1例患者发生MACE。
结论
通过应变分析发现，尽管左心室射血分数、心电图参数或循环生物标志物等传统指标未改变，但SBRT后早期亚临床心脏功能障碍明显。去除蒽环类药物的影响后，GLS仍下降。
试验注册
ClinicalTrials.gov，注册号：NCT04443400。
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