Abstract：Objective To investigate the value of 24-hour dynamic electrocardiogram combined with cardiac troponin I (cTnI) in evaluating the radiation-induced heart disease (RIHD) in chest tumor radiotherapy. Methods From 2015 to 2018, 128 patients with chest tumor who received radiation therapy with/without chemotherapy in the Third People′s Hospital of Linyi were selected to undergo routine ECG examination, 24-hour dynamic ECG examination, cTnI and cardiac color Doppler ultrasound before radiotherapy, 30Gy radiotherapy, 50Gy radiotherapy, after radiotherapy and 3 months after radiotherapy, respectively. The detection rates of 24-hour dynamic electrocardiogram, routine electrocardiogram, cTnI, cardiac color Doppler ultrasound and 24-hour dynamic electrocardiogram combined with cTnI for RIHD were statistically compared. The correlation between glucose level, hypertension and coronary heart disease, combined with chemotherapy, radiation dose and the irradiated area of the heart and the incidence of RIHD was analyzed. Results The detection rates for RIHD did not significantly differ between 24-hour dynamic electrocardiogram and routine electrocardiogram (P>0.05), whereas the detection rates for arrhythmia, atrioventricular block, bundle branch block and ST-T changes of 24-hour dynamic electrocardiogram were significantly higher than those of routine electrocardiogram (all P<0.05). The detection rate of 24-hour dynamic electrocardiogram combined with cTnI was significantly higher compared with that of 24-hour dynamic electrocardiogram, routine electrocardiogram, cTnI or cardiac color Doppler ultrasound alone (all P<0.05). There was a significant difference in RIHD before and after radiotherapy (P<0.05). The incidence rate of RIHD in the radiation therapy combined with chemotherapy group was significantly higher than those in the cisplatin chemotherapy and radiotherapy alone groups, especially in the epirubicin+ cyclophosphamide group (45%, all P<0.05). The incidence rate of RIHD was similar between radiotherapy alone and radiotherapy combined with cisplatin chemotherapy (both P>0.05). After radiation therapy, the grade of RIHD was elevated in 40 cases (31.2%). Diabetes mellitus, hypertension, coronary heart disease, radiotherapy combined with chemotherapy, cardiac Dmean and cardiac V40Gy were the independent factors for the occurrence of grade 1-4 RIHD (all P<0.05). Conclusion The 24-hour dynamic electrocardiogram combined with cTnI is of great value in the detection of RIHD induced by radiotherapy for chest tumors with high detection rate, simple operation and low cost, which is worthy of application in clinical practice.
Wu Xia,Yang Qinghua,Liu Xuejian et al. Application of 24-hour dynamic electrocardiogram combined with cardiac troponin I in evaluating radiation-induced cardiac injury[J]. Chinese Journal of Radiation Oncology, 2020, 29(6): 421-426.
[1] Jameson MG, Kumar S, Vinod SK, et al. Correlation of contouring variation with modeled outcome for conformal non-small cell lung cancer radiotherapy[J]. Radiother 0ncol, 2014, 112(3):332-336. DOI:10.1016/j.radonc.2014.03.019. [2] 王婷, 寇锋军. 肺癌放疗对心电图与心肌酶谱影响的研究[J]. 实用癌症杂志, 2016, 33(11):1890-1892. DOI:10. 3969/j.issn. 100115930.2016.11.046. Wang T, Kou FJ. Effect of lung cancer radiotherapy electro cardiogram and myocardial enzyme[J]. Pract J Cancer, 2016, 33(11):1890-1892. DOI:10.3969/j.issn.100115930.2016.11.046. [3] Hadaegh F, Ehteshami-Afshar S, Hajebrahimi MA, et al. Silent coronary artery disease and incidence of cardiovascular and mortality events at different levels of glucose reg-Ulation:results of greater than a decade follow-up[J]. Int J Cardiol, 2015, 182(3):334-339. DOI:1016/j.10.ijcard.2015.01.017. [4] National Cancer Institute Common. Terminology criteria for adverse events v3.0(CTCAE)[S/OL].[2003-06-10].http:// elect-ronic-applieations/does/cleaev3.pdf. [5] 刘青, 王军, 关嵩, 等. 基础心功能状况与急性放射性心脏损伤的相关性研究[J]. 中华放射医学与防护杂志, 2015, 35(11):825-829. DOI:10.3760/cma.j.issn.0254-5098.2015.11.006. Liu Q, Wang J, Guan S, et a1. Correlation between basic cardiac function and acute radiation-induced heart injury[J]. Chin J Radiol Med Prot, 2015, 35(11):825-829. DOI:10. 3760/cma.j.issn.0254-5098.2015.11.006. [6] 佟颖, 尹勇, 卢洁, 等. 食管癌放疗中左心室肌剂量体积指标评估误差研究[J]. 中华放射肿瘤学杂志, 2018, 27(9):241-244. DOI:10.3760/cma.j.issn.1004-4221.2018.09.009. Tong Y, Yin Y, Lu J, et a1. Analysis of the evaluation errors of dose-volume parameters for left ventricular myocardium in esophageal cancer radiotherapy[J]. Chin J 0ncol, 2018, 27(9):241-244. DOI:10.3760/cma.j.issn.1004-4221.2018.09.009. [7] Nolan MT, Russell DJ, Marwick TH. Long-term risk of heart failure and myocardial dysfunction after thoracic radio-therapy:a systematic review[J]. Can J Cardiol, 2015, 32(7):908-920. DOI:10.1016/j.cjca.2015.12.020. [8] 王军, 龙书敬, 景绍武, 等. 胸部肿瘤放疗后急性左心室功能损伤剂量体积因素分析[J]. 中华放射肿瘤学杂志, 2014, 23(4):326-330. DOI:10.3760/cma.j.issn.1004-4221.2014.04.013. Wang J, Long SJ, Jing SW, et a1. Analysis of dose-volume factors for acute left ventricular damage in patients with thoracic cancer after radiotherapy[J]. Chin J 0ncol, 2014, 23(4):326-330. DOI:10.3760/cma.j.issn.10044221.2014.04.013. [9] Cicek G, Oucar E, Kanar S, et al. Early effect of radiotherapy on left ventricular functions[J]. Am J Cardiol, 2014, 113(7):S70-S71. DOI:10.1016/j.amjcard.2014.01.193. [10] Chen J, Mehta JL. Angiotensin Ⅱ-mediated oxidative stress and proeollagen-1 expression in cardiac fibroblasts:blockade by and pioglitazone[J]. Am J Physiol Heart Circ Physiol, 2006, 291(4):H1738-1745.DOI:10.1152/ ajpheart.00341.2006. [11] 龙书敬, 王军, 王祎, 等. 剂量体积参数对晚期放射性心包积液发生的影响[J]. 中华放射肿瘤学杂志,2015, 24(3):241-244. DOI:10.3760/cma.j.issn.1004-4221.2015.03.004. Long SJ, Wang J, Wang Y, et a1. Effect of dose volume parameters on the occurrence of late radiation pericardial effusion[J]. Chin J Radiat Oncol, 2015, 24(3):241-244. DOI:10.3760/cma.j.issn.1004-4221.2015.03.004. [12] 武亚晶, 王军, 王祎. 放射性心脏损伤发病机制研究进展[J]. 中华放射肿瘤学杂志, 2016, 25(6):657-660. DOI:10.3760/ cma.j.issn.1004-4221.2016.06.025. Wu YJ, Wang J, Wang Y. Research advances in the pathogenesis of radiation-induced myocardial damage[J]. Chin J 0ncol, 2016, 25(6):657-660. DOI:10.3760/cma.j.issn.1004-4221.2016.06.025. [13] Azimzadeh O, Sievert W, Sarioglu H, et a1. Integrative proteomics and targeted transcriptomics analyses in cardiac endothelial cells unravel mechanisms of long-term radiation-induced vascular dysfunction[J]. J Proteome Res, 2015, 14(2):1203-1219. DOI:10.1021/pr501141b. [14] Zhang P, Hu X, Yue J, et a1. Early effection of radiation-induced heart disease using (99m) Tc-MIBI SPECT gated myocardial perfusion imaging in patients with oesophageal cancer during radiotherapy[J]. Radiother Oncol, 2015, 115(2):171-178. DOI:10.1016/j.radonc.2015.04.009. [15] Mihailovic J, Matovina E, Nikoletic K. 18F-fluorideoxy glucose positron emission tomography/computed tomography imaging:artifacts and pitfalls and pitfalls[J]. Med Pregl, 2015, 68(1-2):41-48. DOI:10.2298/MPNS1502041M. [16] 夏国宏, 郑争达, 杨海燕, 等. 动态心电图检查老年冠心病心肌缺血和心律失常临床价值分析[J]. 医学影像学杂志, 2016, 26(2):354-356. Xia GH, Zheng ZD, Yang HY, et a1. Clinical value of dynamic electrocardiographic examination of myocardial ischemia and arrhythmia in elderly patients with coronary heart disease[J]. J Med Imaging, 2016, 26(2):354-356. [17] Body R, Burrows G, Carley S, et a1. Rapid exclusion of acute myocardial infarction in patients with undetectable troponin using a sensitive troponin I assay[J]. Ann Clin Biochem, 2015, 52(5):543-549. DOI:10.1177/0004563215576976. [18] 何佰生, 吴继熊. 血清肌红蛋白、心肌肌钙蛋白Ⅰ联合超敏C反应蛋白对老年性心肌梗死诊断的临床价值[J]. 中国老年学杂志, 2018, 3(38):1331-1333. DOI:10.3969/j.issn.1005-9202.2018.06.022. He BS, Wu JX. Clinical value of serum myoglobin, cardiac troponin I combined with high-sensitivity C-reactive protein in the diagnosis of senile myocardial infarction[J]. Chin J Gerontol, 2018, 3(38):1331-1333. DOI:10. 3969/j. issn.1005-9202.2018.06.022. [19] Fan J, Ma J, Xia N, et a1. Clinical value of combined detection of CK. MB, MYO, cTnI and plasma NT-proBNP in diagnosis of acute myocardial infarction[J]. Clin Lab, 2017, 63(3):427-433. DOI:10.7754/Clin. Lab.2016.160533. [20] Mantarro S, Rossi M, Bonifazi M, et a1. Risk of severe cardiotoxicitv following treatment with trastuzumab:a meta, analvsis of randomized and cohort studies of29 000 women with breast cancer[J]. Int Emerg Med, 2016, 1l (1):123-140. D0l:lO.1007/s11739-015-1362-x.
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