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- Title
Detection of early radiotherapy-induced changes in intrinsic myocardial contractility by ultrasound tissue characterization in patients with early-stage breast cancer.
- Authors
Tuohinen, Suvi Sirkku; Skyttä, Tanja; Huhtala, Heini; Virtanen, Vesa; Virtanen, Marko; Kellokumpu‐Lehtinen, Pirkko‐Liisa; Raatikainen, Pekka
- Abstract
Background Increased cardiovascular morbidity and mortality are major late complications after radiotherapy ( RT) in the thoracic region. Ultrasound tissue characterization ( UTC) is a noninvasive method for the identification of myocardial changes. The aim of this prospective clinical trial was to assess whether the analysis of cyclic variation of integrated backscatter ( CVIBS) can detect early RT-induced myocardial alterations. Methods Seventy-three eligible patients with early-stage breast cancer were evaluated before and immediately after adjuvant RT. Twenty and 53 patients had right-sided and left-sided breast cancer, respectively. None of the patients received chemotherapy. Comprehensive echocardiographic examination included three-dimensional (3D) measurements and UTC analysis of the left ventricular ( LV) septum and posterior wall. Results RT reduced CVIBS in a dose-dependent manner. The mean heart radiation dose over two gray (Gy) reduced the septal CVIBS from 12.0±3.4 to 9.6±2.5 dB ( P<.001) and the posterior wall CVIBS from 12.8±2.7 to 11.3±2.4 dB ( P=.007). The CVIBS remained unchanged when the mean heart RT dose was below 2 Gy. Multivariate analysis showed an independent association with a change in septal CVIBS and the use of aromatase inhibitor (β=2.986, P=.001) and body mass index (β=−0.241, P=.014). The posterior values were worse with higher mean lung dose (β=-.485, P=.018) and with nonsmoking status (β=−2.411, P=.009). Echocardiography parameters showed increased myocardial mass but conventional measurements of the LV systolic function remained unchanged. Conclusions Cyclic variation of integrated backscatter analysis seems to be a sensitive method to detect early RT-induced myocardial changes. Hence, it may be useful in screening of patients needing closer follow-up.
- Subjects
FINLAND; AROMATASE inhibitors; ACADEMIC medical centers; BREAST tumors; CLINICAL trials; STATISTICAL correlation; ECHOCARDIOGRAPHY; ELECTROCARDIOGRAPHY; FISHER exact test; CARDIAC contraction; LEFT heart ventricle; HEART physiology; HEART septum; LONGITUDINAL method; MYOCARDIUM; PROBABILITY theory; RADIATION doses; RADIOTHERAPY; RESEARCH evaluation; RESEARCH funding; T-test (Statistics); TUMOR classification; MULTIPLE regression analysis; BODY mass index; PRE-tests &; post-tests; INTER-observer reliability; DATA analysis software; DESCRIPTIVE statistics; PHYSIOLOGICAL effects of radiation; THERAPEUTICS
- Publication
Echocardiography, 2017, Vol 34, Issue 2, p191
- ISSN
0742-2822
- Publication type
Article
- DOI
10.1111/echo.13433