Siddharth J Trivedi1, Preeti Choudhary2, Queenie Lo3, Hari Prakash Sritharan4, Arvind Iyer5, Vikneswary Batumalai6, Geoff P Delaney6, Liza Thomas7. 1. Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Clinical School, University of Sydney, Australia. 2. Department of Cardiology, Westmead Hospital, Sydney, Australia. 3. South West Clinical School, University of New South Wales, Sydney, Australia; Department of Cardiology, St George Hospital, Sydney, Australia. 4. Department of Cardiology, Liverpool Hospital, Sydney, Australia. 5. South West Clinical School, University of New South Wales, Sydney, Australia; Department of Cardiology, Macquarie University Hospital, Sydney, Australia. 6. South West Clinical School, University of New South Wales, Sydney, Australia; Cancer Therapy Centre, Liverpool Hospital, Sydney, Australia; Ingham Institute of Applied Medical Research, Sydney, Australia. 7. Department of Cardiology, Westmead Hospital, Sydney, Australia; Westmead Clinical School, University of Sydney, Australia; South West Clinical School, University of New South Wales, Sydney, Australia. Electronic address: liza.thomas@sydney.edu.au.
Abstract
BACKGROUND: More than 80% of breast cancer patients receive radiotherapy (RT). However, RT can lead to cardiotoxicity, which usually develops insidiously over years, making diagnosis difficult. It is also unknown whether early identification of at-risk patients might improve long-term outcome. We have previously described subclinical alterations, detected by two-dimensional speckle tracking strain echocardiography, in left ventricular (LV) function immediately following RT in breast cancer. HYPOTHESIS: Subclinical myocardial alterations in LV function consequent to RT cardiotoxicity, observed early, persist at 12 months. METHODS: 40 chemotherapy naive women with left-sided breast cancer, treated with surgery and adjuvant breast RT, were prospectively recruited from two tertiary hospitals. Transthoracic echocardiography was performed at baseline (pre-RT), 6 weeks post-RT, and 12 months post-RT. RESULTS: An increase in LV end diastolic and end systolic volumes was seen from baseline, consistent with persistent LV remodelling; however, due to the increase in both systolic and diastolic volumes over time, no change in LV ejection fraction (EF) was observed. Global longitudinal strain (GLS) and S' velocity remained significantly lower at 12 months post-RT. GLS dropped by >10% in 16 patients and by >20% in 4 patients compared to baseline. CONCLUSIONS: Subclinical cardiac dysfunction using strain analysis, evident early, persists one year after RT, despite unchanged conventional indices such as LVEF. Persistent GLS reduction may be of particular importance in breast cancer patients receiving concomitant chemotherapy. Longer term prospective studies are required to determine if reductions in strain post-RT are associated with future adverse cardiovascular events.
BACKGROUND: More than 80% of breast cancerpatients receive radiotherapy (RT). However, RT can lead to cardiotoxicity, which usually develops insidiously over years, making diagnosis difficult. It is also unknown whether early identification of at-risk patients might improve long-term outcome. We have previously described subclinical alterations, detected by two-dimensional speckle tracking strain echocardiography, in left ventricular (LV) function immediately following RT in breast cancer. HYPOTHESIS: Subclinical myocardial alterations in LV function consequent to RT cardiotoxicity, observed early, persist at 12 months. METHODS: 40 chemotherapy naive women with left-sided breast cancer, treated with surgery and adjuvant breast RT, were prospectively recruited from two tertiary hospitals. Transthoracic echocardiography was performed at baseline (pre-RT), 6 weeks post-RT, and 12 months post-RT. RESULTS: An increase in LV end diastolic and end systolic volumes was seen from baseline, consistent with persistent LV remodelling; however, due to the increase in both systolic and diastolic volumes over time, no change in LV ejection fraction (EF) was observed. Global longitudinal strain (GLS) and S' velocity remained significantly lower at 12 months post-RT. GLS dropped by >10% in 16 patients and by >20% in 4 patients compared to baseline. CONCLUSIONS: Subclinical cardiac dysfunction using strain analysis, evident early, persists one year after RT, despite unchanged conventional indices such as LVEF. Persistent GLS reduction may be of particular importance in breast cancerpatients receiving concomitant chemotherapy. Longer term prospective studies are required to determine if reductions in strain post-RT are associated with future adverse cardiovascular events.
Authors: Médéa Locquet; Daan Spoor; Anne Crijns; Pim van der Harst; Arantxa Eraso; Ferran Guedea; Manuela Fiuza; Susana Constantino Rosa Santos; Stephanie Combs; Kai Borm; Elie Mousseaux; Umit Gencer; Guy Frija; Elisabeth Cardis; Hans Langendijk; Sophie Jacob Journal: Front Oncol Date: 2022-06-28 Impact factor: 5.738
Authors: Elissa A S Polomski; Julius C Heemelaar; Augustinus D G Krol; Marloes Louwerens; Saskia L M A Beeres; Eduard R Holman; J Wouter Jukema; Martin J Schalij; M Louisa Antoni Journal: Cancers (Basel) Date: 2022-05-08 Impact factor: 6.575