Barrett Matthew A, Demissei Biniyam G, Hu Ray, Smith Amanda M, Freedman Gary, Plastaras John, Feigenberg Steven, Berlin Eva, Narayan Hari K, Lefebvre Benedicte, Crosbie Marielle Scherrer, Fradley Michael, Carver Joseph, Chen Jinbo, Ky Bonnie
Department of Medicine, Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Adv Radiat Oncol. 2025 Apr 16;10(7):101786. doi: 10.1016/j.adro.2025.101786. eCollection 2025 Jul.
Our objective was to characterize the early changes in cardiac function after thoracic radiation therapy (RT) using 3D echocardiography.
In a prospective longitudinal cohort study of 69 patients with breast cancer, lung cancer, or mediastinal lymphoma treated with chemotherapy and RT, clinical and 3D echocardiographic data were assessed before, immediately after, and 5 to 9 months after RT completion. 3D left ventricular ejection fraction, global circumferential strain, global longitudinal strain (GLS), average 3D strain, twist, and torsion were quantified. Associations among mean heart dose (MHD), V5, and V30 and early changes in echocardiography-derived measures of cardiac function were assessed with generalized estimating equations.
The median (quartile 1, quartile 3) estimates of MHD ranged from 1.2 Gy (1.0-1.9) in patients with breast cancer ( = 39), to 6.8 Gy (4.0-12.5) in patients with mediastinal lymphoma ( = 17), and 19.4 Gy (11.3-21.7) in patients with lung cancer ( = 13). There were no significant changes in 3D echocardiography measures in patients with breast cancer over time. However, in patients with lung cancer/lymphoma, there was a worsening in 3D left ventricular ejection fraction, GLS, and average 3D strain from pre-RT to RT completion ( < .05). This worsening in 3D GLS persisted at 5 to 9 months ( < .05). Across the entire cohort, MHD, V5, and V30 were not associated with changes in global 3D echocardiography-derived measures ( > .05).
Early abnormalities in cardiac function as measured by 3D echocardiography can be detected following RT. Additional work is needed to define the determinants of changes in cardiac function with RT and long-term impact of early changes on clinical outcomes.
我们的目标是使用三维超声心动图来描述胸部放射治疗（RT）后心脏功能的早期变化。
在一项对69例接受化疗和RT的乳腺癌、肺癌或纵隔淋巴瘤患者进行的前瞻性纵向队列研究中，在RT开始前、结束后即刻以及结束后5至9个月评估临床和三维超声心动图数据。对三维左心室射血分数、整体圆周应变、整体纵向应变（GLS）、平均三维应变、扭转和扭矩进行量化。使用广义估计方程评估平均心脏剂量（MHD）、V5和V30与超声心动图衍生的心脏功能测量指标早期变化之间的关联。
MHD的中位数（四分位数1，四分位数3）估计值范围为：乳腺癌患者为1.2 Gy（1.0 - 1.9）（n = 39），纵隔淋巴瘤患者为6.8 Gy（4.0 - 12.5）（n = 17），肺癌患者为19.4 Gy（11.3 - 21.7）（n = 13）。乳腺癌患者的三维超声心动图测量指标随时间无显著变化。然而，在肺癌/淋巴瘤患者中，从RT前到RT结束，三维左心室射血分数、GLS和平均三维应变有所恶化（P < .05）。这种三维GLS的恶化在5至9个月时持续存在（P < .05）。在整个队列中，MHD、V5和V30与三维超声心动图整体衍生测量指标的变化无关（P > .05）。
RT后可通过三维超声心动图检测到心脏功能的早期异常。需要进一步开展工作来确定RT导致心脏功能变化的决定因素以及早期变化对临床结局的长期影响。
