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Detection of radiotherapy-induced myocardial changes by ultrasound tissue characterisation in patients with breast cancer

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Abstract

Radiotherapy (RT) in the thoracic region is associated with an increased risk of late cardiovascular morbidity and mortality. Ultrasonic tissue characterisation (UTC) is a non-invasive method of identifying changes in myocardial tissue, such as increased fibrosis. The aim of this study was to assess whether UTC can detect early RT-induced myocardial alterations. Seventy-eight eligible patients with early stage breast cancer were evaluated before and immediately after RT. Twenty patients had right-sided and 58 left-sided breast cancer. None received chemotherapy. A comprehensive echocardiographic examination included 3D measurements and UTC of the right ventricular (RV) free wall, ventricular septum and left ventricular (LV) posterior wall. Integrated backscatter calibration was done for the pericardium (cpIBS) and LV cavity (ccIBS). RT for left-sided breast cancer was associated with increased echodensity in the UTC analysis. RV free wall and ventricular septum cpIBS increased from −15.0 ± 7.3 to −13.7 ± 7.9 dB (p = 0.079) and from −18.2 ± 5.1 to -16.0 ± 6.4 dB (p = 0.002), respectively. Likewise, ccIBS in the RV free wall increased from 20.4 ± 5.9 to 22.1 ± 5.6 dB (p = 0.046), and in the LV septum from 17.3 ± 5.2 to 19.8 ± 5.5 dB (p < 0.001). In 3D echocardiography, LV mass increased from 102 ± 18 to 107 ± 18 g (p = 0.005). Patients receiving RT for right-sided breast cancer did not display these changes. Left-sided RT increased myocardial echodensity, particularly in the structures receiving the highest radiation dose. Considering the progressive nature of the RT induced damage, these early changes may help us with individual risk stratification and serve as a tool for screening.

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Acknowledgments

The authors thank research nurses Virpi Räsänen, Hanna Näppilä, and Emmi Vettenranta for their expert assistance during the study. This study was supported by the Pirkanmaa Hospital District, Seppo Nieminen Fund (Grant 150613), Paavo and Eila Salonen Legacy, Ida Montini Fund, the Finnish Foundation for Cardiovascular Research, The Finnish Cultural Foundation, Pirkanmaa Regional Fund and by the Finnish Medical Foundation.

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Authors and Affiliations

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

    Suvi Sirkku Tuohinen, Vesa Virtanen & Marko Virtanen

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

    Tanja Skyttä & Pirkko-Liisa Kellokumpu-Lehtinen

  3. Science Center Pirkanmaa Hospital District and School of Health Sciences, University of Tampere, Tampere, Finland

    Tiina Luukkaala

  4. Department of Medicine, Central Finland Health Care District, University of Eastern Finland, Jyväskylä, Finland

    Pekka Raatikainen

Authors
  1. Suvi Sirkku Tuohinen
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  2. Tanja Skyttä
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  3. Vesa Virtanen
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  4. Marko Virtanen
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  5. Tiina Luukkaala
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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.

Ethics declarations

This study have received financial support in form of grants from non-commercial foundations. Tanja Skyttä has received grants from the Pirkanmaa Hospital District, Seppo Nieminen Fund (grant 150613) and from the Finnish Foundation for Cardiovascular Research. Suvi Tuohinen has received grants from Paavo and Eila Salonen Legacy, Ida Montini Fund, the Finnish Cultural Foundation, Pirkanmaa Regional Fund and by the Finnish Medical Foundation. This study has been approved by the institutional board of ethics and all participants signed informed consent before enrolment in the study. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Tuohinen, S.S., Skyttä, T., Virtanen, V. et al. Detection of radiotherapy-induced myocardial changes by ultrasound tissue characterisation in patients with breast cancer. Int J Cardiovasc Imaging 32, 767–776 (2016). https://doi.org/10.1007/s10554-016-0837-9

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  • DOI: https://doi.org/10.1007/s10554-016-0837-9

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