Predictors of Atrial Fibrillation After Thoracic Radiotherapy

IF 12 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Jacc: Cardiooncology Pub Date : 2024-12-01 DOI:10.1016/j.jaccao.2024.08.007

Santino Butler MD , Hyunsoo No MD , Felicia Guo BA , Gibran Merchant BS , Natalie J. Park BA , Scott Jackson MS , Daniel Eugene Clark MD , Lucas Vitzthum MD , Alex Chin MD, MBA , Kathleen Horst MD , Richard T. Hoppe MD , Billy W. Loo MD, PhD , Maximilian Diehn MD, PhD , Michael Sargent Binkley MD, MS

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引用次数: 0

Abstract

Background

Atrial fibrillation (AF) has been associated with thoracic radiotherapy, but the specific risk with irradiating different cardiac substructures remains unknown.

Objectives

This study sought to examine the relationship between irradiation of cardiac substructures and the risk of clinically significant (grade ≥3) AF.

Methods

We analyzed data from patients who underwent definitive radiotherapy for localized cancers (non–small cell lung, breast, Hodgkin lymphoma, or esophageal) at our institution between 2004 and 2022. The 2-Gy fraction equivalent dose was calculated for cardiac substructures, including the pulmonary veins (PVs), left atrium, sinoatrial node, and left coronary arteries (the left main, left anterior descending, and left circumflex arteries). Competing risk models (subdistribution HRs [sHRs]) for AF incidence were adjusted for the Mayo AF risk score (MAFRS).

Results

Among 539 patients, the median follow-up was 58.8 months. The 5-year cumulative incidence of AF was 11.1% for non–small cell lung cancer, 8.3% for esophageal cancer, 1.3% for breast cancer, and 0.8% for Hodgkin lymphoma. Increased AF risk was associated with a higher PV maximum dose (d_max) (sHR: 1.22; P < 0.001), larger left atrial volume (sHR: 1.01; P = 0.002), greater smoking history in pack-years (sHR: 1.01; P = 0.010), and higher MAFRS (sHR: 1.16; P < 0.001). PV d_max remained a significant predictor of AF across different MAFRS subgroups (P_interaction = 0.11), and a PV d_max >39.7 Gy was linked to a higher AF risk, even when stratified by MAFRS.

Conclusions

PV d_max is a significant predictor of grade ≥3 AF regardless of underlying risk factors. These findings highlight the importance of cardiac substructures in radiation toxicity and suggest that various PV dose metrics should be further validated in clinical settings.

查看原文本刊更多论文

胸部放疗后房颤的预测因素。

背景：心房颤动（AF）与胸部放射治疗有关，但照射不同心脏亚结构的具体风险尚不清楚。目的：本研究旨在探讨心脏亚结构照射与临床显著性（≥3级）af风险之间的关系。方法：我们分析了2004年至2022年在我们机构接受局限性癌症（非小细胞肺癌、乳腺癌、霍奇金淋巴瘤或食管癌）明确放疗的患者的数据。计算心脏亚结构，包括肺静脉（pv）、左心房、窦房结和左冠状动脉（左主干、左前降支和左旋支）的2 gy分数等效剂量。根据Mayo房颤风险评分（MAFRS）对房颤发生率的竞争风险模型（亚分布hr [sHRs]）进行调整。结果：539例患者中位随访时间为58.8个月。非小细胞肺癌的5年累积发病率为11.1%，食管癌为8.3%，乳腺癌为1.3%，霍奇金淋巴瘤为0.8%。增加的房颤风险与较高的PV最大剂量（dmax）相关(sHR: 1.22；P 0.001)，左房容积增大(sHR: 1.01；P = 0.002)，吸烟史以包年计(sHR: 1.01；P = 0.010)，较高的MAFRS (sHR: 1.16；P 0.001)。PV dmax仍然是不同MAFRS亚组中AF的重要预测因子（P交互作用= 0.11），PV dmax bb0 39.7 Gy与较高的AF风险相关，即使按MAFRS分层也是如此。结论：无论潜在的危险因素如何，PV - dmax是≥3级房颤的重要预测因子。这些发现强调了心脏亚结构在辐射毒性中的重要性，并建议在临床环境中进一步验证各种PV剂量指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Jacc: Cardiooncology Multiple-

CiteScore

12.50

自引率

6.30%

发文量

106

期刊介绍： JACC: CardioOncology is a specialized journal that belongs to the esteemed Journal of the American College of Cardiology (JACC) family. Its purpose is to enhance cardiovascular care for cancer patients by publishing high-quality, innovative scientific research and sharing evidence-based knowledge. The journal aims to revolutionize the field of cardio-oncology and actively involve and educate professionals in both cardiovascular and oncology fields. It covers a wide range of topics including pre-clinical, translational, and clinical research, as well as best practices in cardio-oncology. Key areas of focus include understanding disease mechanisms, utilizing in vitro and in vivo models, exploring novel and traditional therapeutics (across Phase I-IV trials), studying epidemiology, employing precision medicine, and investigating primary and secondary prevention. Amyloidosis, cardiovascular risk factors, heart failure, and vascular disease are some examples of the disease states that are of particular interest to the journal. However, it welcomes research on other relevant conditions as well.