Li Tingcui, Zhu Dan, Cui Ming
Department of Intensive Care Unit, Peking University Third Hospital, Beijing, China.
Department of Cardiology, Peking University Third Hospital, Beijing, China.
Echo Res Pract. 2025 Jun 2;12(1):14. doi: 10.1186/s44156-025-00076-1.
Stereotactic body radiotherapy (SBRT) is superior to conventional radiotherapy for the treatment of lung tumors but can lead to radiation-induced heart damage (RIHD). Its risk factors have not been clarified. The purpose of our study was to determine the risk factors for early RIHD in patients undergoing pulmonary SBRT.
We prospectively included patients who planned to receive pulmonary SBRT at our center from January 2020 to May 2021. Two-dimensional speckle tracking echocardiography was performed within 2 months after radiotherapy. The diagnostic criterion for early RIHD was a decrease in global longitudinal strain by ≥ 15% from baseline. Logistic regression was used to explore the risk factors for early RIHD.
A total of 108 patients were included in the study. The overall incidence of early RIHD in the cohort was 41.7%. Significant risk factors, including maximum heart dose, anthracycline use and hypertension, were independently associated with early RIHD, with ORs of 1.058 (95% CI: 1.028-1.089; p < 0.001), 3.524 (95% CI: 1.296-9.577; p = 0.014), and 4.284 (95% CI: 1.424-12.890; p = 0.010), respectively. The cutoff of the maximum heart dose was 27.0 Gy in patients who received anthracycline and 29.3 Gy in those who did not.
Among patients receiving pulmonary SBRT, the maximum heart radiation dose, the use of anthracycline drugs and hypertension are independently associated with the occurrence of early RIHD. These findings could be applied to predict early RIHD and screen for high-risk patients. Individualized cardiac dose limitations may be helpful in improving the long-term prognosis of pulmonary SBRT patients.
立体定向体部放疗（SBRT）在治疗肺部肿瘤方面优于传统放疗，但可能导致放射性心脏损伤（RIHD）。其危险因素尚未明确。我们研究的目的是确定接受肺部SBRT患者早期RIHD的危险因素。
我们前瞻性纳入了2020年1月至2021年5月计划在我们中心接受肺部SBRT的患者。放疗后2个月内进行二维斑点追踪超声心动图检查。早期RIHD的诊断标准为整体纵向应变较基线降低≥15%。采用逻辑回归分析探讨早期RIHD的危险因素。
本研究共纳入108例患者。该队列中早期RIHD的总体发生率为41.7%。包括最大心脏剂量、蒽环类药物使用和高血压在内的显著危险因素与早期RIHD独立相关，其比值比分别为1.058（95%置信区间：1.028 - 1.089；p < 0.001）、3.524（95%置信区间：1.296 - 9.577；p = 0.014）和4.284（95%置信区间：1.424 - 12.890；p = 0.010）。接受蒽环类药物治疗的患者最大心脏剂量的临界值为27.0 Gy，未接受蒽环类药物治疗的患者为29.3 Gy。
在接受肺部SBRT的患者中，最大心脏辐射剂量、蒽环类药物的使用和高血压与早期RIHD的发生独立相关。这些发现可用于预测早期RIHD并筛查高危患者。个体化的心脏剂量限制可能有助于改善肺部SBRT患者的长期预后。
