Early subclinical left ventricular dysfunction post radiotherapy in breast cancer: speckle-tracking echocardiography detects dose-related longitudinal strain changes after irradiation (BACCARAT study) - IRSN - Institut de radioprotection et de sûreté nucléaire Accéder directement au contenu
Communication Dans Un Congrès Année : 2020

Early subclinical left ventricular dysfunction post radiotherapy in breast cancer: speckle-tracking echocardiography detects dose-related longitudinal strain changes after irradiation (BACCARAT study)

Résumé

Background: Breast cancer radiotherapy (BC RT) can be associated with long-term, silent and lately detected cardiotoxicity. Longitudinal strain (LS), based on 2D speckle-tracking echocardiography (2DSTE) can detect early subclinical left ventricular dysfunction. Little is known on the association between RT-induced cardiac doses and LS changes. Purpose: To analyze the relationship between cardiac doses and LS changes after RT in breast cancer patients. Methods: BACCARAT is a monocentric prospective cohort study that included BC patients treated with RT without chemotherapy. Global LS, in particular in the mid-layer of the myocardium (GLS-mid), was measured with 2DSTE before RT and 6 months after RT. We evaluated radiation doses to whole heart, left ventricle (LV), left anterior descending coronary artery (LAD). A subclinical event of cardiotoxicity "decreased GLS-mid≥10% " was defined as a relative decrease≥10%. Results: We included 94 patients (18 right-sided BC, 76 left-sided BC) aged 59±8 years. Mean doses to the heart, LV and LAD were respectively: 3.0±1.3 Gy, 6.6±3.2 Gy and 16.5±7.5 Gyfor the left-sided patients; 0.6±0.5 Gy, 0.2±0.2 Gy and 0.3±0.5 Gy for the right-sided patients. Left-sided BC patients had a significant decrease of GLS-mid (%relative change=9.0%, p=0.02); "decreased GLS-mid≥10%" was detected in 50% of left-sided BC patients and 38% in the right-sided group. We observed dose-response relationships with mean doses to the heart, the LV and the LAD in univariate analysis, that remained marginally significant in adjusted analysis for mean LV dose with an increase of the subclinical event by 11% for each increase of 1 Gy (OR=1.11, 95%CI [0.98 – 1.26]). Conclusion: This is the first study to establish dose-response relationships between BC RT-induced cardiac doses and decreased LS 6 months after RT. With longer follow-up, it remains to be determined whether these dose-related changes are confirmed and if detection of this subclinical LV dysfunction is related to clinical outcome.
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hal-03098810 , version 1 (05-01-2021)

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Sophie Jacob, Valentin Walker, Olivier Fondard, Atul Pathak, Baptiste Pinel, et al.. Early subclinical left ventricular dysfunction post radiotherapy in breast cancer: speckle-tracking echocardiography detects dose-related longitudinal strain changes after irradiation (BACCARAT study). 30es Journées Européennes de la Société Française de Cardiologie / 30th European Days of the French Society of Cardiology, JESFC, Jan 2020, PARIS, France. ⟨hal-03098810⟩
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