Effects of Radiation Therapy on Myocardial Cell Integrity and Pump Function: Which Role for Cardiac Biomarkers?

Nellessen, U; Zingel, Manuela; Hecker, Hartmut; Bahnsen, J.; Borschke, Dorchpagma

doi:10.1159/000313528

Cited by 61 publications

(29 citation statements)

References 46 publications

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“…Because of the prolonged survival time in cancer patients after thoracic radiotherapy, late-onset cardiac diseases create more problems, which include acute and chronic pericardial disease, cardiomyopathy, valvular dysfunction, conduction abnormalities and coronary artery disease, collectively referred to as radiationinduced heart diseases (RIHD). A recent study (Nellessen et al 2010) found that after radiation therapy of lung cancer and breast cancer, in patients the levels of the cardiac biomarkers troponin I and brain natriuretic peptide increased significantly. This study suggested that serial measurements of cardiac biomarkers might facilitate the management of patients undergoing radiation therapy and might help to define subgroups at high risk of developing heart failure.…”

Section: Discussionmentioning

confidence: 99%

Up-regulation of peroxisome proliferator-activated receptor gamma in radiation-induced heart injury in rats

Gao

Zeng

2011

Radiat Environ Biophys

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To explore the expression level and the role of peroxisome proliferator-activated receptor gamma (PPAR-γ) in radiation-induced heart injury in a rat model, thirty-two Sprague-Dawley rats were divided into three groups (the control group, the 15-Gy irradiation group and the 18-Gy irradiation group). Experimental animals were exposed to radiation generated by a linear accelerator at the chest and killed after 3 months. Heart tissues from these animals were removed for Masson staining, PPAR-γ immunohistochemical staining, Western blot analysis and real-time polymerase chain reaction assay (RT-PCR). In addition, the protein expression of matrix metalloprotein-1 (MMP-1), tissue inhibitor of metalloproteinase-1 (TIMP-1) and transforming growth factor type beta1 (TGF-β1), all of which are associated with fibrosis, was measured. Masson staining revealed significant myocardial fibrosis, degeneration and necrosis in rats exposed to radiation. The results of immunohistochemical staining and Western blot analysis showed that PPAR-γ protein expression in hearts of the irradiation groups was significantly higher than in the control group, especially in myocardium and vascular endothelial (p < 0.05). RT-PCR results also showed a parallel increase in PPAR-γ mRNA expression in the heart of the irradiation groups compared with the control group (p < 0.05). The expression of MMP-1 protein was not significantly different in three groups (p > 0.05). The expression of TIMP-1 and TGF-β1 proteins was, however, higher in two irradiation groups than in the control group (p < 0.05). These data demonstrate that PPAR-γ expression is up-regulated on both mRNA and protein levels in heart injured by radiation. PPAR-γ may play an important role in radiation-induced heart injury.

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Section: Discussionmentioning

confidence: 99%

Up-regulation of peroxisome proliferator-activated receptor gamma in radiation-induced heart injury in rats

Gao

Zeng

2011

Radiat Environ Biophys

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“…In another study of 30 patients receiving thoracic chemoradiation, no significant elevation in creatine kinase-myocardial band (CK-MB), troponin, or NT-pro BNP was detected with radiation therapy [74]. In one study both troponin and BNP increased significantly during the study; however, the absolute and mean values remained on a relatively low level (mean preradiation and postradiation troponin I: 0.007 ± 0.008, 0.014 ± 0.01 ng/mL; mean preradiation and post radiation BNP: 123 ± 147, 159 ± 184 pg/mL) [75]. Hence based on current knowledge, cardiac biomarkers are not recommended for evaluation of radiation-induced cardiotoxicity but remain a useful research tool.…”

Section: Role Of Biomarkers In Patients Undergoing Radiation Therapymentioning

confidence: 99%

Radiation-Induced Heart Disease: A Clinical Update

Yusuf

Sami

Daher

2011

Cardiology Research and Practice

171

122

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Cardiovascular diseases and cancer are the two leading causes of morbidity and mortality worldwide. Improvement in cancer therapy has led to increasing number of cancer survivors, some of whom may suffer from adverse cardiovascular effects of radiation therapy. Longterm followup is essential, as the cardiac complication may manifest years after completion of radiation therapy. In this paper, we have discussed the cardiovascular effects of radiation therapy.

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“…Thus, the importance of this study is profound, considering few studies have focused on the mechanism by which thoracic radiation alters cardiac blood biomarker levels. [17][18][19][20] Collectively, these results suggest that RT-induced left ventricular dysfunction and myocardial injury can be evaluated by measuring both TnI and BNP levels as well as SRI before and after RT. Furthermore, measurements of both biomarkers and SRI can be utilized to monitor cardiotoxicity and early signs of cardiovascular dysfunction.…”

Section: Introductionmentioning

confidence: 81%

Measurement of Strain Imaging, Troponin-I and Brain Natriuretic Peptide Levels in Radiotherapy-Induced Cardiac Injury.

Ekici¹,

Çakal²,

Baydar³

et al. 2016

UHOD

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Radiotherapy (RT) of the thorax can damage the pericardium, myocardium, heart valves, and coronary vessels, with the pericardium being the most frequently damaged. The objectives of this study were to evaluate RT-induced left ventricular dysfunction and myocardial injury by measuring cardiac biomarkers, troponin I (TnI) and brain natriuretic peptide (BNP), as well as determin cardiotoxicity and early signs of cardiovascular dysfunction using strain rate imaging (SRI) prior to and following RT. This study included 35 patients diagnosed with thoracic malignancy between January 2011 and October 2013. Of the 35 patients, 22 had left-sided lung cancer and13 had left-sided breast cancer. SRI was performed and TnI and BNP levels were measured prior to and following RT. A total radiation dose of 40-60 Gy (mean, 54.9 ± 8.9 Gy) was applied in lung cancer patients and 50-60 Gy (mean, 51.6 ± 4.9 Gy) was applied in breast cancer patients. No significant difference was observed in TnI or BNP levels prior to and one month following RT. The left ventricular ejection fraction (LVEF) did not differ prior to or after the first month of RT. However, lower right ventricular strain (RVS) and left ventricular strain (LVS) SRI values were detected within the first month following RT. From the results of this study, we conclude that SRI is a sensitive method to detect RT-induced changes in cardiac function that are not typically detected by conventional echocardiographic methods and cardiac biomarkers.Keywords: Radiotherapy, Cardiac toxicity, Strain rate imaging, Left-sided lung cancer, Left ventricular ejection fraction ÖZET Radyoterapiye Bağlı Kardiyak Hasarlanmada Strain Görüntüleme, Troponin-I ve Beyin Natriüretik Peptid Seviyelerinin ÖlçümüRadyoterapi (RT) göğüs bölgesine uygulandığında en çok perikard olmak üzere myokard, kalp damarları ve koroner damarlara zarar verir. Bu çalışmanın amacı RT uygulanmış hastalarda sol ventrikül disfonksiyonunu ve myokard hasarını kardiyak biyobelirteçler, Troponin I (TnI) ve Beyin Natriüretik Peptip (BNP) seviyelerini ölçmek ve erken kardiyovasküler erken belirtileri strain rate görüntüleme (SRG) ile RT öncesi ve sonrası belirlemektir. Bu çalışmaya Ocak 2011 ile Ekim 2013 yılları arasında 35 toraks bölgesi kanseri alındı. Otuz beş hastanın 22'si sol meme kanseri ve 13'ü sol taraf akciğer kanseri idi. SR görüntüleme ve TnI, BNP seviyelerine tedavi öncesi ve sonrası bakıldı. Akciğer kanseri hastalarına 40-60 Gy arası (ortalama, 54.9 ± 8.9 Gy) doz ve meme kanseri hastalarına 50-60 Gy (ortalama, 51.6 ± 4.9 Gy) doz uygulandı. BNP ve TnI seviyelerinde tedavi öncesi ve sonrası istatistiki olarak bir anlamlılık görülmedi. Sol ventrikül ejeksiyon fraksiyonu (SVEF) tedavi öncesi ve tedavi sonrası bir aylık dönemde değişmedi. Fakat, sağ ventrikül gerilimi (SVG) ve sol ventrikül gerilimi (SVG) SRG değerleri tedavi sonrası bir aylık dönemde daha düşük bulundu. Bu çalışmanın sonuçlarına göre, RT hasarının kardiyak fonksiyon üzerindeki erken sonuçlarını tespit etmek konvansiyonel ekokardiyografiye göre S...

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Effects of Radiation Therapy on Myocardial Cell Integrity and Pump Function: Which Role for Cardiac Biomarkers?

Cited by 61 publications

References 46 publications

Up-regulation of peroxisome proliferator-activated receptor gamma in radiation-induced heart injury in rats

Up-regulation of peroxisome proliferator-activated receptor gamma in radiation-induced heart injury in rats

Radiation-Induced Heart Disease: A Clinical Update

Measurement of Strain Imaging, Troponin-I and Brain Natriuretic Peptide Levels in Radiotherapy-Induced Cardiac Injury.

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