The incidence and functional consequences of RT-associated cardiac perfusion defects
The incidence and functional consequences of RT-associated cardiac perfusion defects
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DOI：
10.1016/j.ijrobp.2005.01.029
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发表时间：
2005-09-01
影响因子：
7
通讯作者：
Borges-Neto, S
中科院分区：
文献类型：
--
作者：
Marks, LB;Yu, XL;Borges-Neto, S
目的：左侧乳腺癌的放射治疗（RT）与心功能不全有关。我们在此评估RT诱导的左心室灌注缺陷的时间性质和体积依赖性，以及这些灌注缺陷是否与心壁运动的变化或射血分数的改变有关。方法：从1998年至2001年，114例患者参加了IRB批准的前瞻性临床研究，以评估区域和全球心脏功能的变化后，RT左侧乳腺癌。患者在注射99 mTc司他米比或替曲膦后30至60分钟进行成像。将RT后灌注扫描与RT前研究进行比较，以评估RT诱导的灌注缺陷以及室壁运动和射血分数的功能变化。双尾Fisher精确检验和Cochran-Armitage线性趋势检验用于统计分析。结果：RT后6、12、18和24个月新灌注缺陷的发生率分别为27%、29%、38%和42%。分别约有10%-20%和50%-60%的患者发生了新的缺损，其左心室在RT射野内的比例小于5%和大于5%（p = 0.33 - 0.00008）。室壁运动异常的发生率在有和无灌注缺陷的患者中分别为12%至40%和0%至9%; p值为0.007至0.16，取决于RT后间隔。放射治疗导致约40%的患者在RT后2年内出现体积依赖性灌注缺损。这些灌注缺损与相应的室壁缺损相关。运动异常进一步的研究是必要的，以更好地确定长期功能的后果RT诱导灌注缺陷。(c)2005年爱思唯尔公司
Purpose: Radiation therapy (RT) for left-sided breast cancer has been associated with cardiac dysfunction. We herein assess the temporal nature and volume dependence of RT-induced left ventricular perfusion defects and whether these perfusion defects are related to changes in cardiac wall motion or alterations in ejection fraction.Methods: From 1998 to 2001, 114 patients were enrolled onto an IRB-approved prospective clinical study to assess changes in regional and global cardiac function after RT for left-sided breast cancer. Patients were imaged 30 to 60 minutes after injection of technetium 99m sestamibi or tetrofosmin. Post-RT perfusion scans were compared with the pre-RT studies to assess for RT-induced perfusion defects as well as functional changes in wall motion and ejection fraction. Two-tailed Fisher's exact test and the Cochran-Armitage test for linear trends were used for statistical analysis.Results: The incidence of new perfusion defects 6, 12, 18, and 24 months after RT was 27%, 29%, 38%, and 42%, respectively. New defects occurred in approximately 10% to 20% and 50% to 60% of patients with less than 5%, and greater than 5%, of their left ventricle included within the RT fields, respectively (p = 0.33 to 0.00008). The rates of wall motion abnormalities in patients with and without perfusion defects were 12% to 40% versus 0% to 9%, respectively; p values were 0.007 to 0.16, depending on the post-RT interval.Conclusions: Radiation therapy causes volume-dependent perfusion defects in approximately 40% of patients within 2 years of RT. These perfusion defects are associated with corresponding wall-motion abnormalities. Additional study is necessary to better define the long-term functional consequences of RT-induced perfusion defects. (c) 2005 Elsevier Inc.