International Journal of Hematology and Oncology 2024, Vol 34, Num 1 Page(s): 075-082
Measurement of Strain Imaging, Troponin-I and Brain Natriuretic Peptide Levels in Radiotherapy- Induced Cardiac Injury

Kemal EKICI1, Beytullah CAKAL2, Onur BAYDAR3, Alpaslan MAYADAGLI4, Sinem DENIZ CAKAL2, Oguz KARACA2, M. Onur OMAYGENC2

1Inonu University Faculty of Medicine, Department of Radiation Oncology, Malatya,TURKEY
2Medipol University Faculty of Medicine, Department of Cardiology, Istanbul,TURKEY
3Avicenna Hospital, Department of Cardiology, Istanbul,TURKEY
4Bezmi-Alem University, Department of Radiation Oncology, Istanbul,TURKEY

Keywords: Radiotherapy, Cardiac toxicity, Strain rate imaging, Left-sided lung cancer, Left ventricular ejection fraction
Radiotherapy (RT) of the thorax can damage the pericardium, myocardium, heart valves, and coronary vessels, with the pericardium being the most frequently damaged. The objective of this study was to evaluate RT-induced left ventricular dysfunction and myocardial injury by measuring cardiac biomarkers, troponin I (TnI) and brain natriuretic peptide (BNP), as well as determining cardiotoxicity and early signs of cardiovascular dysfunction using strain rate imaging (SRI) prior to and following RT. This study included 35 patients diagnosed with thoracic malignancy between January 2011 and October 2013. Of the 35 patients, 22 had left-sided lung cancer and13 had left-sided breast cancer. SRI was performed and TnI and BNP levels were measured prior to and following RT. A total radiation dose of 40–60 Gy (mean, 54.9 ± 8.9 Gy) was applied in lung cancer patients and 50-60 Gy (mean, 51.6 ± 4.9 Gy) was applied in breast cancer patients. No significant difference was observed in TnI or BNP levels prior to and one month following RT. The left ventricular ejection fraction (LVEF) did not differ prior to or after the first month of RT. However, lower right ventricular strain (RVS) and left ventricular strain (LVS) SRI values were detected within the first month following RT. From the results in this study, we conclude that SRI is a sensitive method to detect RT-induced changes in cardiac function that are not typically detected by conventional echocardiographic methods and cardiac biomarkers.