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Radiotherapy-induced global and regional differences in early-stage left-sided versus right-sided breast cancer patients: speckle tracking echocardiography study

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Abstract

Radiotherapy (RT) to the thoracic region increases late cardiovascular morbidity and mortality. The impact of breast cancer laterality on cardiac function is largely unknown. The aim of this prospective study was to compare RT-induced changes in left-sided and right-sided breast cancer patients using speckle tracking echocardiography (STE). Sixty eligible patients with left-sided breast cancer and 20 with right-sided breast cancer without chemotherapy were evaluated prospectively before and early after RT. A comprehensive echocardiographic examination included three dimensional measurements and STE of the left ventricle (LV). The global longitudinal strain (GLS) was reduced from −18.3 ± 3.1 to −17.2 ± 3.3% (p = 0.003) after RT in patients with left-sided breast cancer. Similarly, regional analysis showed a reduction in the apical strain from −18.7 ± 5.3 to −16.7 ± 4.9% (p = 0.002) and an increase in basal values from −21.6 ± 5.0 to −23.3 ± 4.9% (p = 0.024). Patients with right-sided breast cancer showed deterioration in basal anterior strain segments from −26.3 ± 7.6 to −18.8 ± 8.9% (p < 0.001) and in pulsed tissue Doppler by 0.825 [0.365, 1.710] cm/s (p < 0.001). In multivariable analysis, the use of aromatase inhibitor (β = −2.002, p = 0.001) and decreased LV diastolic volume (β = −0.070, p = 0.025) were independently associated with the decrease in GLS. RT caused no changes in conventional LV systolic measurements. RT induced regional changes corresponded to the RT fields. Patients with left-sided breast cancer experienced apical impact and global decline, whereas patients with right-sided breast cancer showed basal changes. The regional differences in cardiac impact warrant different methods in screening and in the follow-up of patients with left-sided versus right-sided breast cancer.

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Acknowledgements

The authors thank research nurses Virpi Räsänen, Hanna Näppilä and Emmi Vettenranta for their expert assistance during the study and Helene Schmidt for the drawings.

Funding

This study was supported by the Pirkanmaa Hospital District, Seppo Nieminen Fund (Grant No. 150613), Paavo and Eila Salonen Legacy, the Ida Montin Fund, the Finnish Foundation for Cardiovascular Research, the Competitive State Research Financing of the Expert Responsibility Area of Tampere University Hospital (Grant No. 95021) and the Finnish Cultural Foundation, the Pirkanmaa Regional Fund and the Finnish Medical Foundation.

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Authors and Affiliations

  1. Heart Center Co., Heart Hospital, Tampere University Hospital and School of Medicine, University of Tampere, PO Box 2000, 33521, Tampere, Finland

    Suvi Sirkku Tuohinen & Vesa Virtanen

  2. Department of Oncology, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland

    Tanja Skyttä & Pirkko-Liisa Kellokumpu-Lehtinen

  3. Department of Pediatrics, Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland

    Tuija Poutanen

  4. School of Health Sciences, University of Tampere, Tampere, Finland

    Heini Huhtala

  5. Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland

    Pekka Raatikainen

Authors
  1. Suvi Sirkku Tuohinen
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  2. Tanja Skyttä
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  3. Tuija Poutanen
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  4. Heini Huhtala
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  5. Vesa Virtanen
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  6. Pirkko-Liisa Kellokumpu-Lehtinen
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  7. Pekka Raatikainen
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Correspondence to Suvi Sirkku Tuohinen.

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None of the authors have any conflict of interest to declare, financial or otherwise.

Ethical approval

This study has been approved by the local ethics committee and it has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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All persons included in this study have given informed consent prior their inclusion in the study.

Research involving animal rights

This study does not contain any studies with animals performed by any of the authors.

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Tuohinen, S.S., Skyttä, T., Poutanen, T. et al. Radiotherapy-induced global and regional differences in early-stage left-sided versus right-sided breast cancer patients: speckle tracking echocardiography study. Int J Cardiovasc Imaging 33, 463–472 (2017). https://doi.org/10.1007/s10554-016-1021-y

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  • DOI: https://doi.org/10.1007/s10554-016-1021-y

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