Subclinical Left Ventricular Dysfunction Detected by Speckle-Tracking Echocardiography in Breast Cancer Patients Treated With Radiation Therapy : A Six-Month Follow-Up Analysis (MEDIRAD EARLY-HEART study)
Copyright © 2022 Locquet, Spoor, Crijns, van der Harst, Eraso, Guedea, Fiuza, Santos, Combs, Borm, Mousseaux, Gencer, Frija, Cardis, Langendijk and Jacob..
Background: In the case of breast cancer (BC), radiotherapy (RT) helps reduce locoregional recurrence and BC-related deaths but can lead to cardiotoxicity, resulting in an increased risk of long-term major cardiovascular events. It is therefore of primary importance to early detect subclinical left ventricular (LV) dysfunction in BC patients after RT and to determine the dose-response relationships between cardiac doses and these events.
Methods: Within the frame of the MEDIRAD European project (2017-2022), the prospective multicenter EARLY-HEART study (ClinicalTrials.gov Identifier: NCT03297346) included chemotherapy naïve BC women aged 40-75 years and treated with lumpectomy and adjuvant RT. Myocardial strain analysis was provided using speckle-tracking echocardiography performed at baseline and 6 months following RT. A global longitudinal strain (GLS) reduction >15% between baseline and follow-up was defined as a GLS-based subclinical LV dysfunction. Individual patient dose distributions were obtained using multi-atlas-based auto-segmentation of the heart. Dose-volume parameters were studied for the whole heart (WH) and left ventricle (LV).
Results: The sample included 186 BC women (57.5 ± 7.9 years, 64% left-sided BC). GLS-based subclinical LV dysfunction was observed in 22 patients (14.4%). These patients had significantly higher cardiac exposure regarding WH and LV doses compared to patients without LV dysfunction (for mean WH dose: 2.66 ± 1.75 Gy versus 1.64 ± 0.96 Gy, p = 0.01). A significantly increased risk of subclinical LV dysfunction was observed with the increase in the dose received to the WH [ORs from 1.13 (V5) to 1.74 (Dmean); p <0.01] and to the LV [ORs from 1.10 (V5) to 1.46 (Dmean); p <0.01]. Based on ROC analysis, the LV-V5 parameter may be the best predictor of the short-term onset of subclinical LV dysfunction.
Conclusion: These results highlighted that all cardiac doses were strongly associated with the occurrence of subclinical LV dysfunction arising 6 months after BC RT. Whether measurements of GLS at baseline and 6 months after RT combined with cardiac doses can early predict efficiently subclinical events occurring 24 months after RT remains to be investigated.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:12 |
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| Enthalten in: |
Frontiers in oncology - 12(2022) vom: 15., Seite 883679 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Locquet, Médéa [VerfasserIn] |
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| Links: |
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| Themen: |
Breast cancer |
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| Anmerkungen: |
Date Revised 16.07.2022 published: Electronic-eCollection ClinicalTrials.gov: NCT03297346 Citation Status PubMed-not-MEDLINE |
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| doi: |
10.3389/fonc.2022.883679 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
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| 245 | 1 | 0 | |a Subclinical Left Ventricular Dysfunction Detected by Speckle-Tracking Echocardiography in Breast Cancer Patients Treated With Radiation Therapy |b A Six-Month Follow-Up Analysis (MEDIRAD EARLY-HEART study) |
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| 500 | |a ClinicalTrials.gov: NCT03297346 | ||
| 500 | |a Citation Status PubMed-not-MEDLINE | ||
| 520 | |a Copyright © 2022 Locquet, Spoor, Crijns, van der Harst, Eraso, Guedea, Fiuza, Santos, Combs, Borm, Mousseaux, Gencer, Frija, Cardis, Langendijk and Jacob. | ||
| 520 | |a Background: In the case of breast cancer (BC), radiotherapy (RT) helps reduce locoregional recurrence and BC-related deaths but can lead to cardiotoxicity, resulting in an increased risk of long-term major cardiovascular events. It is therefore of primary importance to early detect subclinical left ventricular (LV) dysfunction in BC patients after RT and to determine the dose-response relationships between cardiac doses and these events | ||
| 520 | |a Methods: Within the frame of the MEDIRAD European project (2017-2022), the prospective multicenter EARLY-HEART study (ClinicalTrials.gov Identifier: NCT03297346) included chemotherapy naïve BC women aged 40-75 years and treated with lumpectomy and adjuvant RT. Myocardial strain analysis was provided using speckle-tracking echocardiography performed at baseline and 6 months following RT. A global longitudinal strain (GLS) reduction >15% between baseline and follow-up was defined as a GLS-based subclinical LV dysfunction. Individual patient dose distributions were obtained using multi-atlas-based auto-segmentation of the heart. Dose-volume parameters were studied for the whole heart (WH) and left ventricle (LV) | ||
| 520 | |a Results: The sample included 186 BC women (57.5 ± 7.9 years, 64% left-sided BC). GLS-based subclinical LV dysfunction was observed in 22 patients (14.4%). These patients had significantly higher cardiac exposure regarding WH and LV doses compared to patients without LV dysfunction (for mean WH dose: 2.66 ± 1.75 Gy versus 1.64 ± 0.96 Gy, p = 0.01). A significantly increased risk of subclinical LV dysfunction was observed with the increase in the dose received to the WH [ORs from 1.13 (V5) to 1.74 (Dmean); p <0.01] and to the LV [ORs from 1.10 (V5) to 1.46 (Dmean); p <0.01]. Based on ROC analysis, the LV-V5 parameter may be the best predictor of the short-term onset of subclinical LV dysfunction | ||
| 520 | |a Conclusion: These results highlighted that all cardiac doses were strongly associated with the occurrence of subclinical LV dysfunction arising 6 months after BC RT. Whether measurements of GLS at baseline and 6 months after RT combined with cardiac doses can early predict efficiently subclinical events occurring 24 months after RT remains to be investigated | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a EARLY-HEART cohort | |
| 650 | 4 | |a MEDIRAD | |
| 650 | 4 | |a breast cancer | |
| 650 | 4 | |a cardiac dysfunction | |
| 650 | 4 | |a dosimetry | |
| 650 | 4 | |a radiotherapy | |
| 650 | 4 | |a strain imaging | |
| 700 | 1 | |a Spoor, Daan |e verfasserin |4 aut | |
| 700 | 1 | |a Crijns, Anne |e verfasserin |4 aut | |
| 700 | 1 | |a van der Harst, Pim |e verfasserin |4 aut | |
| 700 | 1 | |a Eraso, Arantxa |e verfasserin |4 aut | |
| 700 | 1 | |a Guedea, Ferran |e verfasserin |4 aut | |
| 700 | 1 | |a Fiuza, Manuela |e verfasserin |4 aut | |
| 700 | 1 | |a Santos, Susana Constantino Rosa |e verfasserin |4 aut | |
| 700 | 1 | |a Combs, Stephanie |e verfasserin |4 aut | |
| 700 | 1 | |a Borm, Kai |e verfasserin |4 aut | |
| 700 | 1 | |a Mousseaux, Elie |e verfasserin |4 aut | |
| 700 | 1 | |a Gencer, Umit |e verfasserin |4 aut | |
| 700 | 1 | |a Frija, Guy |e verfasserin |4 aut | |
| 700 | 1 | |a Cardis, Elisabeth |e verfasserin |4 aut | |
| 700 | 1 | |a Langendijk, Hans |e verfasserin |4 aut | |
| 700 | 1 | |a Jacob, Sophie |e verfasserin |4 aut | |
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