2D-STE allows early detection of right ventricular dysfunction in thoracic tumor patients receiving radiotherapy, and patient age and mean heart dose (MHD) are factors associated with radiotherapy-induced right ventricular dysfunction.
Key Findings
Results
Right ventricular fractional area change, left ventricular global longitudinal strain, and right ventricular free wall longitudinal strain all decreased during thoracic radiotherapy compared with baseline.
40 patients were enrolled (22 males, median age 61.0 years) at the Fourth Hospital of Hebei Medical University between May 2021 and May 2022.
RV FAC during treatment was (45.48±4.67)% vs. (51.75±6.55)% at baseline, P<0.05.
LVGLS during treatment was (-16.83±2.99)% vs. (-18.85±3.00)% at baseline, P<0.05.
RVFWLS during treatment was (-25.69±2.29)% vs. (-28.86±1.26)% at baseline, P<0.05.
Results
RV FAC, LVGLS and RVFWLS remained lower than baseline after radiotherapy was completed.
Post-treatment echocardiography was performed 1 to 2 days after the end of radiotherapy.
The abstract reports that these parameters stayed below baseline levels after treatment (all P<0.05).
Results
Mean heart dose (MHD) and patient age were linearly correlated with ΔRVFWLS and with the percentage change in RVFWLS.
Multiple linear regression examined age, cardiac volume, radiotherapy parameters and other factors.
MHD and age were associated with both ΔRVFWLS and percentage change in RVFWLS (all P<0.05).
ΔRVFWLS was defined as post-treatment RVFWLS minus baseline.
Results
MHD had high discriminative performance for predicting right ventricular dysfunction, and age had moderate performance.
The AUC of MHD was 0.984 with a cut-off value of 2,020 cGy.
The AUC of age was 0.766 with a cut-off value of 56.5 years.
RV dysfunction was defined as RV FAC <35% or tricuspid annular systolic peak velocity at the RV free wall <10 cm/s.
Results
About 28% of patients developed right ventricular dysfunction over a median follow-up of 82 days.
11 of 40 patients (28%) developed right ventricular dysfunction.
Median follow-up duration was 82 days.
Results
Patients aged ≥56.5 years had a higher cumulative incidence of right ventricular dysfunction endpoint events than those aged <56.5 years.
Kaplan-Meier analysis gave Plog-rank=0.020.
The 56.5-year threshold was derived from ROC analysis.
Results
Patients with MHD ≥2,020 cGy had a higher cumulative incidence of right ventricular dysfunction endpoint events than those with MHD <2,020 cGy.
Kaplan-Meier analysis gave Plog-rank<0.001.
The 2,020 cGy threshold was derived from ROC analysis (AUC 0.984).
Conclusions
The authors conclude that 2D-STE permits early detection of radiotherapy-related right ventricular dysfunction.
Strain changes (RVFWLS) were detectable at the mid-treatment point (after half of the prescribed dose) and after treatment.
Assessments were performed at baseline, mid-treatment and 1-2 days post-treatment.
What This Means
This small study followed 40 people receiving radiation therapy for tumors in the chest. Heart ultrasound exams, including a technique called speckle-tracking that measures how much the heart muscle shortens with each beat, were done before radiotherapy, halfway through, and 1-2 days after finishing. Measures of both right and left heart function dropped by the midpoint of treatment and stayed lower afterward.
Older age and a higher average radiation dose to the heart were linked to larger declines in right heart muscle function. Doses of about 2,020 cGy or more and age of about 56.5 years or older marked groups with more right heart dysfunction. Overall, 11 of 40 patients (28%) developed right heart dysfunction over a median follow-up of about 82 days. The dose threshold distinguished affected patients very well in this sample, and the age threshold did so moderately well.
This research suggests that speckle-tracking ultrasound may be able to pick up early changes in right heart function during radiotherapy, and that heart dose and age may help identify who is more at risk. The study was small, from a single hospital, and had short follow-up, so the thresholds would need confirmation in larger studies and the long-term meaning of these changes remains unclear.
Liu R, Xu L, Zhao Z, Han R. (2026). [Two-dimensional speckle-tracking echocardiography in radiotherapy-related right heart dysfunction and analysis of associated risk factors].. Zhonghua xin xue guan bing za zhi. https://doi.org/10.3760/cma.j.cn112148-20260811-00507