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)
BackgroundIn 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 ve...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-06-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2022.883679/full |
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| author | 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 Elisabeth Cardis Elisabeth Cardis Hans Langendijk Sophie Jacob |
| author_facet | 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 Elisabeth Cardis Elisabeth Cardis Hans Langendijk Sophie Jacob |
| author_sort | Médéa Locquet |
| collection | DOAJ |
| description | BackgroundIn 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.MethodsWithin 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).ResultsThe 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.ConclusionThese 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. |
| first_indexed | 2024-12-12T14:21:11Z |
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| id | doaj.art-c750388d8e114d63b50e678fd6fc7a8f |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-12T14:21:11Z |
| publishDate | 2022-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-c750388d8e114d63b50e678fd6fc7a8f2022-12-22T00:21:48ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2022-06-011210.3389/fonc.2022.883679883679Subclinical 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)Médéa Locquet0Daan Spoor1Anne Crijns2Pim van der Harst3Arantxa Eraso4Ferran Guedea5Manuela Fiuza6Susana Constantino Rosa Santos7Stephanie Combs8Kai Borm9Elie Mousseaux10Umit Gencer11Guy Frija12Elisabeth Cardis13Elisabeth Cardis14Elisabeth Cardis15Hans Langendijk16Sophie Jacob17Laboratory of Epidemiology, Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, FranceDepartment of Radiation Oncology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, NetherlandsDepartment of Radiation Oncology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, NetherlandsDepartment of Radiation Oncology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, NetherlandsDepartment of Radiation Oncology, Institut Catala Oncologia (ICO), Girona, SpainDepartment of Radiation Oncology, Institut Catala Oncologia (ICO), Girona, SpainCentro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina da Universidade de Lisboa, Lisbon, PortugalCentro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina da Universidade de Lisboa, Lisbon, PortugalDepartment of Radiation Oncology, Technical University of Munich (TUM-MED), Munich, GermanyDepartment of Radiation Oncology, Technical University of Munich (TUM-MED), Munich, GermanyDepartment of Radiology, Paris-Descartes University and INSERM970, Hôpital Européen Georges Pompidou, Paris, FranceDepartment of Radiology, Paris-Descartes University and INSERM970, Hôpital Européen Georges Pompidou, Paris, FranceDepartment of Radiology, Paris-Descartes University and INSERM970, Hôpital Européen Georges Pompidou, Paris, FranceBarcelona Institute of Global Health (ISGlobal), Barcelona, SpainPompeu Fabra University, Barcelona, SpainSpanish Consortium for Research and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, SpainDepartment of Radiation Oncology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, NetherlandsLaboratory of Epidemiology, Institute for Radiation Protection and Nuclear Safety (IRSN), Fontenay-Aux-Roses, FranceBackgroundIn 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.MethodsWithin 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).ResultsThe 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.ConclusionThese 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.https://www.frontiersin.org/articles/10.3389/fonc.2022.883679/fullMEDIRADbreast cancerradiotherapycardiac dysfunctiondosimetrystrain imaging |
| spellingShingle | 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 Elisabeth Cardis Elisabeth Cardis Hans Langendijk Sophie Jacob 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) Frontiers in Oncology MEDIRAD breast cancer radiotherapy cardiac dysfunction dosimetry strain imaging |
| title | 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) |
| title_full | 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) |
| title_fullStr | 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) |
| title_full_unstemmed | 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) |
| title_short | 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) |
| title_sort | 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 |
| topic | MEDIRAD breast cancer radiotherapy cardiac dysfunction dosimetry strain imaging |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2022.883679/full |
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