The Early Effects On Cardiac Diastolic Function In Patients After Thoracic Tumors Radiotherapy

Objective To observe the early influence of cardiac diastolic function after chest radiotherapy,to analyze the influence of different clinical factors,the cardiac exposure dose and volume on diastolic function,and explore the influencing factors of cardiac diastolic dysfunction after radiotherapy.To provide theoretical basis for early prediction of cardiac diastolic function changes caused by radiotherapy and effective intervention measures,in order to reduce the mortality of cardiac-related events and improve living quality of cancer patients.Methods Prospectively collect the patients who received chest radiotherapy for the first time in ×××Hospital from November 2018 to November 2019,excluding patients with a history of heart disease before radiotherapy and those who received trastuzumaba(Herceptin)therapy.All the patients were examined by echocardiography one day before radiotherapy,during radiotherapy(the 14 th day)and one day after radiotherapy,and their systolic and diastolic functions were measured.The whole heart and the left ventricle were delineated in Raystation,generated DVH and obtained the mean dose(Dmean),dose parameters D10-50(the dose received by 10-50% of the heart volume)and volume parameters V5-40(the percentage of tissue irradiated by 5-40 Gy in the organ)of the whole heart and the left ventricle.The basic information of all patients was collected in the electronic medical record system,mainly including age,gender,height,weight,diagnosis,treatment plan(whether there is chemotherapy history,targeted drug treatment history and specific drug treatment plan),smoking history,hypertension,diabetes and other clinical data.Results A total of 31 patients were enrolled according to the inclusion criteria,with an average age of 53.87±11.33 years,11 males and 20 females.22 patients had history of chemotherapy(71.0%),7 cases had a history of anthracycline use(22.6%),5 cases had hypertension(16.1%),7 cases had diabetes(22.6%),9 cases had smoking history(29.0%),and 10 cases BMI?24(32.3%).All patients had normal baseline diastolic function and completed radiotherapy successfully as planned.Single-factor repeated measurement analysis of variance showed that G-LSs,G-LSe,ventricular septum e',lateral wall e',E /e' and LAVI values changed significantly after radiotherapy(P<0.05),while other cardiac ultrasonic measurements showed no statistical significance.Two-factor repeated measurement analysis of variance showed that whole heart V5,left ventricular Dmean and D10 had interaction with time and suggested a significant effect on change of G-LSs.Left ventricular Dmean,D10 and V10-40 had interaction with time and reflected significant effect on lateral wall e '.Left ventricular D10 interacted with time and has a significant influence on the change of the E/e'.Heart Dmean,D10 and V5 had interaction with time and significant effect on change of LAVI(P<0.05).Two-factor repeated measurement analysis of variance showed that the interaction between time and the clinical characteristics(age,BMI?24,history of chemotherapy,history of anthracyclines,history of hypertension,diabetes,and smoking)had no significant effect on the change of cardiac diastolic function.Conclusion Cardiac diastolic function was impaired in the early stage after radiotherapy in patients with chest tumors.Heart Dmean,D10,V5 and left ventricular Dmean,D10,V10-40 had significant effects on cardiac diastolic function.Age,BMI,chemotherapy history,anthracycline application history,hypertension,diabetes,smoking history and other clinical factors had no significant effect on diastolic function.