부산대학교 도서관

Introduction: The 2D echocardiographic features of radiation-associated cardiac disease (RACD) are well-described including aorto-mitral curtain thickness. However, the 3D speckle tracking echocardiographic strain patterns and their predictive risk for all-cause mortality are not well known in RACD.Methods: We studied 441 patients with RACD (63.7 ± 13.4 y; 62.4% female) seen in our institution. Echocardiographic strain patterns of their initial echocardiograms were reviewed. 3D strain analysis using TOMTEC was performed for left ventricle (LV), right ventricle (RV), and left atrium (LA). Primary outcome was all-cause mortality. We constructed 3 Cox regression models: (1) unadjusted; (2) minimally adjusted for age and sex; (3) adjusted for 42 covariates including CV risk factors, cancer history, cardiac treatments, and cardiac function.Results: During a median 6.8 (95%CI 5.7-7.4) years follow-up, 245 patients died. In the unadjusted model, all LV, RV, and LA strain metrics (except for RV free wall strain) were significantly associated with all-cause death. After comprehensive adjustment for 42 covariates, the strain metrics (except for left atrial contraction strain) remained significantly associated with mortality. The strongest predictor for mortality was reduced LV GLS (HR 0.93, 95%CI 0.89-0.96; p <0.001).Conclusions: Abnormal strain patterns in patients with RACD were associated with increased all-cause mortality independently from other known risk factors. Abnormal strain is a distinct feature of radiation-induced cardiac disease, possibly indicating the mechanism of radiation associated cardiac disease.