Left Ventricular Speckle Tracking Echocardiography Changes Among Early-stage Breast Cancer Patients Three Years After Radiotherapy

Abstract

Background/Aim: Chest radiotherapy (RT) doubles late cardiac mortality. This study aimed to evaluate the evolution of cardiac changes in speckle tracking echocardiography during a three-year follow-up. Materials and Methods: This prospective study included 81 chemotherapy-naïve early-stage breast cancer patients who were evaluated at baseline, immediately after RT and three years after RT. Sixty-one patients had left-sided (LSBC) and 20 right-sided breast cancer (RSBC). Results: Global longitudinal strain (GLS) declined from baseline-18.0±3.3% to-17.0±3.0% (p=0.015) at the three-year follow-up examination. A decline over 15% (GLS15) was observed in 19 (27%) patients. GLS15 was independently associated with aromatase inhibitor use (β=-1.977, p=0.001). In regional analysis, patients with LSBC had apical strain decline by 3.2±5.5% (p<0.001) and patients with RSBC showed basal rotation decline by 1.8˚ (-0.2˚, 3.8˚) (p=0.030). Conclusion: Even contemporary RT induced progressive global and regional decline in speckle tracking analysis. The regional changes complied with RT fields. Radiotherapy (RT) is an integral part of the treatment in half of cancer patients (1). Over 80% of early-stage breast cancer patients receive adjuvant RT, which reduces the local recurrence risk by half and, the late breast cancer-related mortality by a fifth. The overall survival of early-stage breast cancer patients at 5 years is 91% in Finland (www.cancerregistry.fi). However, RT induces adverse effects in healthy tissue, which may lead to late dysfunction in adjacent organs. The heart is an important organ at risk, especially in left-sided breast cancer (LSBC). Breast cancer RT increases cardiac mortality and morbidity almost twofold in long-term cohorts collected from patients treated with older RT techniques (2, 3). The modern RT treatment protocols have reduced cardiac radiation exposure. However, the clinical impact of the reduced cardiac dose will not be revealed until long-term data are available. In the meantime, early and mid-term cardiac changes are valuable in predicting later sequelae and to reveal the mechanism and time-course of RT-induced heart disease (RIDH). RIHD can manifest as coronary artery disease, valvular lesions, heart failure, pericardial changes or conduction abnormalities. These changes occur usually several years or decades after RT treatment (2-4). The early subclinical RTinduced cardiac changes precede the late manifestations. Perfusion defects and changes in strain and strain rate corresponding to the RT fields have been detected 0-6 months after RT with myocardial perfusion imaging and with echocardiography (5-7). After chemotherapy, an early change in global longitudinal strain (GLS) predicts later decline in left ventricular ejection fraction (LVEF), but the knowledge of post-RT strain evolution is sparse (8, 9). The aim of our study was to explore the evolution of early RT-induced changes in speckle tracking echocardiography (STE) in early-stage breast cancer patients within the first three years after ...

Myocardial deformation after radiotherapy: a layer-specific and territorial longitudinal strain analysis in a cohort of left-sided breast cancer patients (BACCARAT study)

“…This may explain the strongest decrease of the LS at the apical level as previously observed [6]. Moreover, in a previous study of patients with left-sided breast cancer [12], the segments with a significant strain reduction just after RT and 3 years post-RT were similar to those found in our study, particularly with regards to the mid-anterolateral segment and the apical-inferior segment. However, the association between LS decrease and cardiac dose is far to be clear and our correlations between LS decrease and doses to the different cardiac structures were low (under 0.3), as previously observed in several other studies [6,10,11].…”

“…Global longitudinal strain (LS) is often considered as an optimal parameter of deformation for the early detection of sub-clinical left ventricular dysfunction [4,5]. Many studies on early myocardial dysfunction after BC RT showed a significant decrease in global LS among left-sided breast cancer patients at different times post-RT, from few weeks to 3 years [6][7][8][9][10][11][12][13][14], whereas no measurable alteration of left ventricular ejection fraction (LVEF) was observed. Moreover, some previous works showed an association between the global LS decrease after BC RT and the mean heart dose or the mean left ventricular dose [15].…”

Sleep Disorders Before and During the COVID-19 Pandemic in Patients Assigned to Adjuvant Radiotherapy for Breast Cancer

“…Treatment protocols of patients with primary breast cancer most often include radiotherapy following breast-conserving surgery or mastectomy (2). Radiotherapy for breast cancer can be associated with acute and late toxicities (19)(20)(21). Being scheduled for radiotherapy may cause psychological distress that can lead to significant sleep disorders.…”

ST2 levels increased and were associated with changes in left ventricular systolic function during a three-year follow-up after adjuvant radiotherapy for breast cancer

“…Multivariable linear regression analyses were performed to model the change in GLS and in left ventricular ejection fraction (LVEF) over three years, adjusting the models with the change in ST2 over three years, age, body mass index (BMI), laterality of BCa, aromatase inhibitor (AI) use and hypertension. Additionally, patients were divided into two groups: >15 and ≤ 15% relative change in global longitudinal strain (GLS) [ 24 ], a clinically meaningful change [ 24 , 25 ]. Differences between these groups were tested using multivariable logistic regression analysis, adjusting the model with the change in ST2 over three years, AI use, age and the mean dose to the left anterior descending coronary artery (LAD).…”