作为肺癌放射性心脏毒性生物标志物的基线心脏参数

IF 12 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Jacc: Cardiooncology Pub Date : 2024-08-01 DOI:10.1016/j.jaccao.2024.05.009
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引用次数: 0

摘要

背景放疗引起的心脏毒性是肺癌治疗中的一项重大挑战,因为心脏与肺在解剖学上非常接近,再加上患者中心血管风险因素的高发率。本研究旨在评估常规临床和影像学心脏参数在确定放疗(RT)后发生重大心脏不良事件(MACE)和死亡率的 "高风险 "患者方面的预测价值。方法回顾性审查了 2015 年至 2020 年期间在一个中心使用现代计划技术接受非小细胞肺癌最终 RT 治疗的患者的病历。心脏事件由心脏病专家核实,死亡率数据由国家登记处确认。对RT计划扫描的心脏亚结构进行了自动分割,以进行回顾性结构和剂量分析,并研究了它们与临床因素的相关性。在考虑死亡竞争风险的同时,使用 Fine-Gray 模型来分析两者之间的关系。结果在纳入研究的 478 名患者中,77 人(16%)发生了 88 次 MACE,中位发生时间为 16.3 个月。原有心脏疾病负担越重,MACE累积发生率越高(55% [95% CI: 12%-20%] vs 16% [95% CI: 35%-71%]; P <0.001)。RT 计划扫描显示的左心房和左心室增大分别与 5 年后房性心律失常(14% [95% CI:9%-20%] vs 4% [95% CI:2%-8%];P = 0.001)和心力衰竭(13% [95% CI:8%-18%] vs 6% [95% CI:3%-10%];P = 0.007)的累积发生率相关。然而,心肌梗死与冠状动脉钙化无关(4.2% [95% CI: 2%-7%] vs 0% [95% CI: 0%-0%];P = 0.094)。结论本研究结果表明,心脏病史和 RT 计划扫描参数可为前瞻性评估肺癌患者 RT 后的心脏毒性风险提供潜在的实用性。
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Baseline Cardiac Parameters as Biomarkers of Radiation Cardiotoxicity in Lung Cancer

Background

Radiation-induced cardiotoxicity poses a significant challenge in lung cancer management because of the close anatomical proximity of the heart to the lungs, compounded by a high prevalence of cardiovascular risk factors among patients.

Objectives

The aim of this study was to assess the predictive value of routinely available clinical and imaging-based cardiac parameters in identifying “high risk” patients for major adverse cardiac events (MACE) and mortality following radiation therapy (RT).

Methods

The medical records of patients who underwent definitive RT for non–small cell lung cancer using modern planning techniques at a single center between 2015 and 2020 were retrospectively reviewed. Cardiac events were verified by cardiologists, and mortality data were confirmed with the national registry. Cardiac substructures were autosegmented on RT planning scans for retrospective structure and dose analysis, and their correlation with clinical factors was examined. Fine-Gray models were used to analyze relationships while considering the competing risk for death.

Results

Among 478 patients included in the study, 77 (16%) developed 88 MACE, with a median time to event of 16.3 months. A higher burden of pre-existing cardiac diseases was associated with an increased cumulative incidence of MACE (55% [95% CI: 12%-20%] vs 16% [95% CI: 35%-71%]; P < 0.001). Left atrial and left ventricular enlargement on RT planning scans was associated with cumulative incidence of atrial arrhythmia (14% [95% CI: 9%-20%] vs 4% [95% CI: 2%-8%]; P = 0.001) and heart failure (13% [95% CI: 8%-18%] vs 6% [95% CI: 3%-10%]; P = 0.007) at 5 years, respectively. However, myocardial infarction was not associated with the presence of coronary calcium (4.2% [95% CI: 2%-7%] vs 0% [95% CI: 0%-0%]; P = 0.094). No cardiac imaging metrics were found to be both clinically and statistically associated with survival.

Conclusions

The present findings suggest that cardiac history and RT planning scan parameters may offer potential utility in prospectively evaluating cardiotoxicity risk following RT for patients with lung cancer.

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来源期刊
CiteScore
12.50
自引率
6.30%
发文量
106
期刊介绍: JACC: CardioOncology is a specialized journal that belongs to the esteemed Journal of the American College of Cardiology (JACC) family. Its purpose is to enhance cardiovascular care for cancer patients by publishing high-quality, innovative scientific research and sharing evidence-based knowledge. The journal aims to revolutionize the field of cardio-oncology and actively involve and educate professionals in both cardiovascular and oncology fields. It covers a wide range of topics including pre-clinical, translational, and clinical research, as well as best practices in cardio-oncology. Key areas of focus include understanding disease mechanisms, utilizing in vitro and in vivo models, exploring novel and traditional therapeutics (across Phase I-IV trials), studying epidemiology, employing precision medicine, and investigating primary and secondary prevention. Amyloidosis, cardiovascular risk factors, heart failure, and vascular disease are some examples of the disease states that are of particular interest to the journal. However, it welcomes research on other relevant conditions as well.
期刊最新文献
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