Sławiński Grzegorz, Hawryszko Maja, Lasocka-Koriat Zofia, Romanowska Anna, Myszczyński Kamil, Wrona Anna, Daniłowicz-Szymanowicz Ludmiła, Lewicka Ewa
Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland.
1st Department of Cardiology, Faculty of Medicine, Medical University of Gdańsk, 80-210 Gdańsk, Poland.
Cancers (Basel). 2024 May 23;16(11):1979. doi: 10.3390/cancers16111979.
Anticancer treatment is associated with many side effects, including those involving the cardiovascular system. While many studies are available on the effects of radiotherapy (RT) on the left ventricle (LV), studies are lacking on the early effects of RT on the structure and function of the right ventricle (RV). Our study aims to assess, using modern echocardiographic techniques, the effect of irradiation on RV systolic function in the mid-term follow-up of patients undergoing RT for lung cancer (LC).
This single-center, prospective study included consecutive patients with LC who were referred for treatment with definite radiotherapy and chemotherapy (study group) or chemotherapy only (control group).
The study included 43 patients with a mean age of 64.9 ± 8.1 years. Cancer treatment-related RV toxicity (CTR-RVT) was found in 17 patients (40%). Early reductions in TAPSE values were observed among patients in the study group (20.3 mm vs. 22.1 mm, = 0.021). Compared to baseline, there was a significant reduction in RV global longitudinal strain (RV GLS) in the study group immediately after the treatment (-21.1% vs. -18.4%, = 0.02) and also at 3 months after RT (-21.1% vs. -19.1%, = 0.021). A significant reduction in the RV FWLS value was also observed at 3 months after the end of the treatment (-23.8% vs. -21.8, = 0.046). There were no significant changes in the three-dimensional right ventricular ejection fraction (3DRVEF) during the follow-up. We found a correlation ( = 0.003) between the mean dose of radiation to the RV and 3DRVEF when assessed immediately after RT. The mean dose of radiation to the heart correlated with RV free-wall longitudinal strain (RV FWLS) immediately after RT ( = 0.03).
RV cardiotoxicity occurs in nearly half of patients treated for lung cancer. TAPSE is an important marker of deterioration of RV function under LC treatment. Compared to 3DRVEF, speckle tracking echocardiography is more useful in revealing deterioration of RV systolic function after radiotherapy.
抗癌治疗会带来许多副作用，包括涉及心血管系统的副作用。虽然有许多关于放疗（RT）对左心室（LV）影响的研究，但缺乏关于RT对右心室（RV）结构和功能早期影响的研究。我们的研究旨在使用现代超声心动图技术，评估肺癌（LC）放疗患者中期随访中照射对RV收缩功能的影响。
这项单中心前瞻性研究纳入了连续的LC患者，这些患者被转诊接受明确的放疗和化疗（研究组）或仅接受化疗（对照组）。
该研究纳入了43例患者，平均年龄为64.9±8.1岁。在17例患者（40%）中发现了癌症治疗相关的RV毒性（CTR-RVT）。研究组患者中观察到TAPSE值早期降低（20.3mm对22.1mm，P=0.021）。与基线相比，研究组在治疗后立即（-21.1%对-18.4%，P=0.02）以及放疗后3个月（-21.1%对-19.1%，P=0.021）时RV整体纵向应变（RV GLS）显著降低。在治疗结束后3个月时，RV游离壁纵向应变（RV FWLS）值也显著降低（-23.8%对-21.8，P=0.046）。随访期间三维右心室射血分数（3DRVEF）无显著变化。放疗后立即评估时，我们发现RV平均辐射剂量与3DRVEF之间存在相关性（P=0.003）。放疗后立即，心脏平均辐射剂量与RV游离壁纵向应变（RV FWLS）相关（P=0.03）。
近一半接受肺癌治疗的患者会发生RV心脏毒性。TAPSE是LC治疗下RV功能恶化的重要标志物。与3DRVEF相比，斑点追踪超声心动图在揭示放疗后RV收缩功能恶化方面更有用。
