Berlin Eva, Ko Kyunga, Ma Lin, Messing Ian, Hollawell Casey, Smith Amanda M, Taunk Neil K, Narayan Vivek, Upshaw Jenica N, Clark Amy S, Shah Payal D, Knollman Hayley, Bhattacharya Saveri, Koropeckyj-Cox Daniel, Wang Jessica, Yegya-Raman Nikhil, Han Ivy S, Lefebvre Benedicte, Li Tang, Wilcox Nicholas S, Jung Wonyoung, Chen Jinbo, Freedman Gary M, Ky Bonnie
Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Division of Cardiology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
JACC CardioOncol. 2025 Apr;7(3):219-230. doi: 10.1016/j.jaccao.2025.01.012. Epub 2025 Mar 4.
Radiation therapy (RT) improves breast cancer outcomes, but cardiac morbidity remains a concern.
This study sought to evaluate changes in cardiac function after RT and the relationship between cardiac dose metrics and echocardiography-derived measures of function.
In a longitudinal cohort study of women with breast cancer, radiation cardiac dose metrics and core lab quantitated echocardiographic measures of cardiac function were evaluated. Dose metrics included the whole heart, left ventricle, right ventricle, and left anterior descending artery (LAD). Echocardiographic measures included left ventricular ejection fraction (LVEF), longitudinal strain, circumferential strain, E/e' (ratio of early diastolic mitral inflow velocity to early diastolic mitral annular tissue velocity), Ea/Es (ventricular arterial coupling; ratio of effective arterial elastance to end systolic elastance), and right ventricular fractional area change. The mean change in echocardiographic measures over time and the association between cardiac dose metrics and echocardiographic measures were estimated by repeated-measures multivariable linear regression via generalized estimating equations.
The cohort included 303 participants (median age 52 years, 33.3% African American) who received adjuvant RT (2010-2019) with a median mean heart dose of 1.19 Gy (Q1-Q3: 0.75-2.61 Gy), were followed over a median of 5.1 years (Q1-Q3: 3.2-7.1 years). Across all participants, there was a modest increase in LVEF (52.1% pre-RT to 54.3% at 5 years; P < 0.001) but a worsening in sensitive measures of function, such as circumferential strain (-23.7% pre-RT to -21.0% at 5 years; P = 0.003). Among left-sided/bilateral breast cancer participants, changes in cardiac function were observed across all parameters (P < 0.05). The maximum LAD dose was associated with a modest worsening in LVEF, longitudinal strain, circumferential strain, and E/e'.
Over a median of 5.1 years, modest changes in cardiac function were observed with RT. Maximum LAD dose was associated with a worsening in systolic and diastolic function parameters.
放射治疗（RT）可改善乳腺癌的治疗效果，但心脏发病率仍是一个令人担忧的问题。
本研究旨在评估放疗后心脏功能的变化以及心脏剂量指标与超声心动图测量的功能之间的关系。
在一项针对乳腺癌女性的纵向队列研究中，评估了放射心脏剂量指标和核心实验室定量超声心动图测量的心脏功能。剂量指标包括全心、左心室、右心室和左前降支动脉（LAD）。超声心动图测量包括左心室射血分数（LVEF）、纵向应变、圆周应变、E/e'（舒张早期二尖瓣流入速度与舒张早期二尖瓣环组织速度之比）、Ea/Es（心室动脉耦合；有效动脉弹性与收缩末期弹性之比）和右心室分数面积变化。通过广义估计方程，采用重复测量多变量线性回归估计超声心动图测量随时间的平均变化以及心脏剂量指标与超声心动图测量之间的关联。
该队列包括303名参与者（中位年龄52岁，33.3%为非裔美国人），他们接受了辅助放疗（2010 - 2019年），中位平均心脏剂量为1.19 Gy（第一四分位数 - 第三四分位数：0.75 - 2.61 Gy），中位随访时间为5.1年（第一四分位数 - 第三四分位数：3.2 - 7.1年）。在所有参与者中，LVEF有适度增加（放疗前为52.1%，5年时为54.3%；P < 0.001），但功能的敏感测量指标有所恶化，如圆周应变（放疗前为 - 23.7%，5年时为 - 21.0%；P = 0.003）。在左侧/双侧乳腺癌参与者中，所有参数均观察到心脏功能变化（P < 0.05）。最大LAD剂量与LVEF、纵向应变、圆周应变和E/e'的适度恶化相关。
在中位5.1年的时间里，放疗后观察到心脏功能有适度变化。最大LAD剂量与收缩和舒张功能参数的恶化相关。
