3-Year Follow-Up of Radiation-Associated Changes in Diastolic Function by Speckle Tracking Echocardiography

Suvi Sirkku Tuohinen; Tanja Skyttä; Heini Huhtala; Tuija Poutanen; Vesa Virtanen; Pirkko-Liisa Kellokumpu-Lehtinen; Pekka Raatikainen

doi:10.1016/j.jaccao.2021.03.005

3-Year Follow-Up of Radiation-Associated Changes in Diastolic Function by Speckle Tracking Echocardiography

JACC CardioOncol. 2021 Jun 15;3(2):277-289. doi: 10.1016/j.jaccao.2021.03.005. eCollection 2021 Jun.

Authors

Suvi Sirkku Tuohinen^{1

2}, Tanja Skyttä^{3

4}, Heini Huhtala⁵, Tuija Poutanen^{6

7}, Vesa Virtanen^{2

4}, Pirkko-Liisa Kellokumpu-Lehtinen^{3

4}, Pekka Raatikainen¹

Affiliations

¹ Heart and Lung Center, Helsinki University Central Hospital, Helsinki University, Helsinki, Finland.
² Heart Hospital, Tampere University Hospital, University of Tampere, Tampere, Finland.
³ Department of Oncology, Tampere University Hospital, Tampere, Finland.
⁴ Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
⁵ Faculty of Social Sciences, Tampere University, Tampere, Finland.
⁶ Center for Child Health Research, Tampere, Finland.
⁷ Department of Pediatrics, Faculty of Medicine and Heath Technology, Tampere University Hospital and Tampere University, Tampere, Finland.

Abstract

Background: Radiation therapy (RT) results in myocardial changes consisting of diffuse fibrosis, which may result in changes in diastolic function.

Objectives: The aim of this study was to explore RT-associated changes in left ventricular (LV) diastolic function.

Methods: Sixty chemotherapy-naive patients with left-sided, early-stage breast cancer were studied with speckle tracking echocardiography at 3 time points: prior to, immediately after, and 3 years after RT. Global and regional early diastolic strain rate (SRe) were quantified, as were parameters of systolic function.

Results: Regional changes in SRe, particularly the apical and anteroseptal segments, were observed over time and were more evident than global changes. The apical SRe declined from a median of 1.24 (interquartile range: 1.01 to 1.39) s^-1 at baseline to 1.02 (interquartile range: 0.79 to 1.15) s^-1 at 3 years of follow-up (p < 0.001). This decline was associated with the left ventricular maximal radiation dose (β = 0.36, p = 0.007). The global SRe was <1.00 s^-1 (SRe_dep) in 11 (18.3%) patients at baseline, 21 (35%) patients (p = 0.013) post-RT, and 17 (28.3%) patients (p = 0.051) at 3 years. SRe_dep post-RT was independently associated with baseline cardiac abnormalities (odds ratio: 0.26; 95% confidence interval: 0.08 to 0.84; p = 0.025); SRe_dep at 3 years of follow-up was associated with the baseline Charlson comorbidity index (odds ratio: 2.36; 95% confidence interval: 1.17 to 4.77; p = 0.017). Diastolic function abnormalities were evident even in patients with preserved global longitudinal strain at 3 years.

Conclusions: RT resulted in changes in the SRe in the apical and anteroseptal segments over 3 years of follow-up. Changes in SRe apical segments were present even in patients with preserved systolic function and were independently associated with RT dose and cardiovascular comorbidities.

Keywords: CI, confidence interval; DLVmax, maximal left ventricular radiation dose; GLS, global longitudinal strain; IQR, interquartile range; LAVI, left atrial volume indexed to body surface area; LV, left ventricular; LVEF, left ventricular ejection fraction; RT, radiotherapy; SR, strain rate; SRe, early diastolic strain rate; SReapex, apical early diastolic strain rate; SRedep, global early diastolic strain rate <1 s-1; SRs, systolic strain rate; breast cancer; diastolic strain rate; radiotherapy; speckle tracking echocardiography; ΔGLS15, relative decline of more than 15% in global longitudinal strain.