RESUMEN
BACKGROUND: Early electrocardiogram (ECG) changes after breast cancer radiotherapy (RT) have been reported, but their characteristics and associated factors are largely unknown. This study aimed to explore early RT-induced ECG changes and to compare them with echocardiography changes. MATERIALS AND METHODS: Sixty eligible patients with chemotherapy-naïve left-sided and 20 with right-sided breast cancer were evaluated with echocardiography, blood samples and ECG before and after RT. RESULTS: RT-induced ECG changes in the anterior leads. T-Wave changes were most frequent. T-Wave decline was associated independently with patient age (ß=-0.245, p=0.005), mean heart radiation dose (ß=1.252, p=0.001) and global systolic strain rate change (ß=7.943, p=0.002). T-Wave inversion was associated independently with mean heart radiation dose (ß=0.143, p<0.001), global longitudinal strain change (ß=0.053, p=0.017) and posterior calibrated integrated backscatter (ß=-0.022, p=0.049). CONCLUSION: RT-induced ECG changes were prevalent and associated with functional and structural changes in echocardiography. ECG could be used for post-RT cardiac screening.
Asunto(s)
Neoplasias de la Mama/radioterapia , Ecocardiografía , Electrocardiografía , Corazón/diagnóstico por imagen , Corazón/efectos de la radiación , Traumatismos por Radiación/diagnóstico , Anciano , Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Ecocardiografía/efectos de la radiación , Electrocardiografía/efectos de la radiación , Femenino , Humanos , Persona de Mediana Edad , Estadificación de Neoplasias , Dosis de Radiación , Traumatismos por Radiación/etiología , Dosificación Radioterapéutica , Radioterapia Adyuvante/efectos adversos , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/etiología , Función Ventricular Izquierda/efectos de la radiaciónRESUMEN
Anthracyclines are very potent drugs in the therapy of malignancies in childhood. The major dose limiting adverse effect of these drugs is the risk of dilated cardiomyopathy. We performed a retrospective study on 168 patients who were treated with anthracyclines for a malignant disease with or without chest radiation at the department of Pediatric Hematology and Oncology at the University of Duesseldorf between 2000 and 2004. During and after chemotherapy the patients were screened by echocardiography and ECG examinations prior to each administration of anthracyclines. Only four patients presented with adverse cardiac events, one of whom developed acute cardiac failure. This patient was additionally treated with chest radiation. Three of the four patients showed intermittent arrhythmias, mainly supraventricular tachycardia. One of them presented with atrial ectopic tachycardia and left ventricular dysfunction. We conclude that the frequency of cardiac sequelae after chemotherapy with anthracyclines is low under present guidelines. Detection of early cardiac sequelae may be more difficult than in the past. Only one patient with cardiac sequelae in our study group was diagnosed by regular performed examinations for cardiac sequelae of chemotherapy. We therefore need to modify our screening methods to increase the effectiveness of detection of cardiac dysfunction prior to clinical manifestation.