Abstract：
BACKGROUND: Breast radiotherapy (RT) induces diffuse myocardial changes, which may increase the incidence of heart failure with preserved ejection fraction. This study aimed to evaluate the early signs of diffuse fibrosis after RT and their evolution during a six-year follow-up.
METHODS: Thirty patients with early-stage left-sided breast cancer were studied with echocardiography and electrocardiography (ECG) at baseline, after RT, and at three-year and six-year follow-up visits. Echocardiography analysis included an off-line analysis of integrated backscatter (IBS). ECG was analysed for fragmented QRS (fQRS). In addition, cardiac magnetic resonance (CMR) imaging was performed at the six-year control. The left ventricle 16-segment model was used in cardiac imaging, and respective local radiation doses were analysed.
RESULTS: Regional myocardial reflectivity in inferoseptal segments increased by 2.02 (4.53) dB (p = 0.026) and the percentage of leads with fQRS increased from 9.2 to 16.4% (p = 0.002) during the follow-up. In CMR imaging, abnormal extracellular volume (ECV) and T1 mapping values were found with anteroseptal and apical localization in a median of 3.5 (1.00-5.75) and 3 (1.25-4.00) segments, respectively. A higher left ventricle radiation dose was associated with an increased likelihood of having changes simultaneously in CMR and echocardiography (OR 1.26, 95% Cl. 1.00-1.59, p = 0.047).
CONCLUSIONS: After radiotherapy, progressive changes in markers of diffuse myocardial fibrosis were observed in a multimodal manner in ECG and echocardiography. Changes in echocardiography and abnormal values in CMR were localized in the septal and apical regions, and multiple changes were associated with higher radiation doses.
METHODS: Thirty patients with early-stage left-sided breast cancer were studied with echocardiography and electrocardiography (ECG) at baseline, after RT, and at three-year and six-year follow-up visits. Echocardiography analysis included an off-line analysis of integrated backscatter (IBS). ECG was analysed for fragmented QRS (fQRS). In addition, cardiac magnetic resonance (CMR) imaging was performed at the six-year control. The left ventricle 16-segment model was used in cardiac imaging, and respective local radiation doses were analysed.
RESULTS: Regional myocardial reflectivity in inferoseptal segments increased by 2.02 (4.53) dB (p = 0.026) and the percentage of leads with fQRS increased from 9.2 to 16.4% (p = 0.002) during the follow-up. In CMR imaging, abnormal extracellular volume (ECV) and T1 mapping values were found with anteroseptal and apical localization in a median of 3.5 (1.00-5.75) and 3 (1.25-4.00) segments, respectively. A higher left ventricle radiation dose was associated with an increased likelihood of having changes simultaneously in CMR and echocardiography (OR 1.26, 95% Cl. 1.00-1.59, p = 0.047).
CONCLUSIONS: After radiotherapy, progressive changes in markers of diffuse myocardial fibrosis were observed in a multimodal manner in ECG and echocardiography. Changes in echocardiography and abnormal values in CMR were localized in the septal and apical regions, and multiple changes were associated with higher radiation doses.
摘要：
背景：乳腺放疗（RT）引起弥漫性心肌改变，这可能会增加射血分数保留的心力衰竭的发生率。这项研究旨在评估RT后弥漫性纤维化的早期体征及其在六年随访期间的演变。
方法：对30例早期左侧乳腺癌患者进行基线超声心动图和心电图检查。在RT之后,以及为期三年和六年的后续访问。超声心动图分析包括整合反向散射(IBS)的离线分析。分析心电图的碎裂QRS（fQRS）。此外,在6年对照时进行心脏磁共振(CMR)成像.左心室16段模型用于心脏成像，并分析了各自的局部辐射剂量。
结果：在随访期间，下间隔段的局部心肌反射率增加了2.02（4.53）dB（p=0.026），具有fQRS的导线百分比从9.2％增加到16.4％（p=0.002）。在CMR成像中，发现异常的细胞外体积（ECV）和T1标测值，前间隔和根尖定位的中位数为3.5（1.00-5.75）和3（1.25-4.00），分别。较高的左心室辐射剂量与CMR和超声心动图同时变化的可能性增加有关（OR1.26，95％Cl。1.00-1.59，p=0.047）。
结论：放疗后，在心电图和超声心动图中以多模态方式观察到弥漫性心肌纤维化标志物的进行性变化.超声心动图的变化和CMR的异常值位于间隔和心尖区，多种变化与较高的辐射剂量有关。
方法：对30例早期左侧乳腺癌患者进行基线超声心动图和心电图检查。在RT之后,以及为期三年和六年的后续访问。超声心动图分析包括整合反向散射(IBS)的离线分析。分析心电图的碎裂QRS（fQRS）。此外,在6年对照时进行心脏磁共振(CMR)成像.左心室16段模型用于心脏成像，并分析了各自的局部辐射剂量。
结果：在随访期间，下间隔段的局部心肌反射率增加了2.02（4.53）dB（p=0.026），具有fQRS的导线百分比从9.2％增加到16.4％（p=0.002）。在CMR成像中，发现异常的细胞外体积（ECV）和T1标测值，前间隔和根尖定位的中位数为3.5（1.00-5.75）和3（1.25-4.00），分别。较高的左心室辐射剂量与CMR和超声心动图同时变化的可能性增加有关（OR1.26，95％Cl。1.00-1.59，p=0.047）。
结论：放疗后，在心电图和超声心动图中以多模态方式观察到弥漫性心肌纤维化标志物的进行性变化.超声心动图的变化和CMR的异常值位于间隔和心尖区，多种变化与较高的辐射剂量有关。
