{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:33:14Z","timestamp":1760149994398,"version":"build-2065373602"},"reference-count":37,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T00:00:00Z","timestamp":1696377600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCDD"],"abstract":"<jats:p>1. Background: We sought to determine acute and subacute changes in cardiac function after proton beam (PBT) and photon beam (PhT) radiotherapy (RT) using conventional and two-dimensional speckle tracking echocardiography (2D-STE) in patients with malignant breast and thoracic tumors. 2. Methods: Between March 2016 and March 2017, 70 patients with breast or thoracic cancer were prospectively enrolled and underwent transthoracic echocardiography with comprehensive strain analysis at pretreatment, mid-treatment, end of treatment, and 3 months after RT. 3. Results: PBT was used to treat 44 patients; PhT 26 patients. Mean \u00b1 SD age was 55 \u00b1 12 years; most patients (93%) were women. The median (interquartile range) of the mean heart dose was lower in the PBT than the PhT group (47 [27\u201379] vs. 217 [120\u2013596] cGy, respectively; p &lt; 0.001). Ejection fraction did not change in either group. Only the PhT group had reduced systolic tissue Doppler velocities at 3 months. 2D-STE showed changes in endocardial and epicardial longitudinal, radial, and circumferential early diastolic strain rate (SRe) in patients undergoing PhT (global longitudinal SRe, pretreatment vs. end of treatment (p = 0.04); global circumferential SRe, pretreatment vs. at 3-month follow-up (p = 0.003); global radial SRe, pretreatment vs. at 3-month follow-up (p = 0.02) for endocardial values). Epicardial strain values decreased significantly only in patients treated with PhT. Patients in the PhT group had a significant decrease in epicardial global longitudinal systolic strain rate (GLSRs) (epicardial GLSRs, at baseline vs. at end of treatment [p = 0.009]) and in GCSRe and GRSRe (epicardial GCSRe, at baseline vs. at 3-month follow-up (p = 0.02); epicardial GRSRe, at baseline vs. at 3-month follow-up (p = 0.03)) during treatment and follow-up. No changes on 2D-STE were detected in the PBT group. 4. Conclusions: Patients who underwent PhT but not PBT had reduced tissue Doppler velocities and SRe values during follow-up, suggesting early myocardial relaxation abnormalities. PBT shows promise as a cardiac-sparing RT technology.<\/jats:p>","DOI":"10.3390\/jcdd10100418","type":"journal-article","created":{"date-parts":[[2023,10,4]],"date-time":"2023-10-04T11:58:57Z","timestamp":1696420737000},"page":"418","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Detection of Early Myocardial Dysfunction by Imaging Biomarkers in Cancer Patients Undergoing Photon Beam vs. Proton Beam Radiotherapy: A Prospective Study"],"prefix":"10.3390","volume":"10","author":[{"given":"Muhannad Aboud","family":"Abbasi","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia","family":"Bruno","sequence":"additional","affiliation":[{"name":"Hypertension Unit, Department of Medical Sciences, Citt\u00e0 della Salute e della Scienza, University of Torino, 3-10126 Torino, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Di Stefano","sequence":"additional","affiliation":[{"name":"Hypertension Unit, Department of Medical Sciences, Citt\u00e0 della Salute e della Scienza, University of Torino, 3-10126 Torino, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Garcia Bello","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nadia N.","family":"Laack","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly S.","family":"Corbin","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas J.","family":"Whitaker","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6800-3521","authenticated-orcid":false,"given":"Patricia A.","family":"Pellikka","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert W.","family":"Mutter","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55905, USA"},{"name":"Department of Pharmacology, Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hector R.","family":"Villarraga","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine Mayo Clinic, Rochester, MN 55905, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1016\/j.echo.2013.07.005","article-title":"Expert consensus for multi-modality imaging evaluation of cardiovascular complications of radiotherapy in adults: A report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography","volume":"26","author":"Lancellotti","year":"2013","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1016\/j.ijrobp.2009.09.064","article-title":"Radiation-related heart disease: Current knowledge and future prospects","volume":"76","author":"Darby","year":"2010","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1056\/NEJMoa1209825","article-title":"Risk of ischemic heart disease in women after radiotherapy for breast cancer","volume":"368","author":"Darby","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1171","DOI":"10.1200\/JCO.2016.69.8480","article-title":"Validation and Modification of a Prediction Model for Acute Cardiac Events in Patients With Breast Cancer Treated With Radiotherapy Based on Three-Dimensional Dose Distributions to Cardiac Substructures","volume":"35","author":"Ta","year":"2017","journal-title":"J. Clin. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2200","DOI":"10.1056\/NEJMra1608986","article-title":"Recent Developments in Radiotherapy","volume":"377","author":"Citrin","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.ijrobp.2015.09.018","article-title":"Initial Report of a Prospective Dosimetric and Clinical Feasibility Trial Demonstrates the Potential of Protons to Increase the Therapeutic Ratio in Breast Cancer Compared With Photons","volume":"95","author":"Bradley","year":"2016","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1016\/j.ijrobp.2016.01.036","article-title":"Consensus Statement on Proton Therapy in Early-Stage and Locally Advanced Non-Small Cell Lung Cancer","volume":"95","author":"Chang","year":"2016","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2855","DOI":"10.1200\/JCO.2014.55.1945","article-title":"Promise and pitfalls of heavy-particle therapy","volume":"32","author":"Mitin","year":"2014","journal-title":"J. Clin. Oncol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.3109\/0284186X.2015.1011756","article-title":"Proton beam versus photon beam dose to the heart and left anterior descending artery for left-sided breast cancer","volume":"54","author":"Lin","year":"2015","journal-title":"Acta Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"4229","DOI":"10.1093\/eurheartj\/ehac244","article-title":"2022 ESC Guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS)","volume":"43","author":"Lyon","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1093\/ejechocard\/jep221","article-title":"Experimental validation of left ventricular transmural strain gradient with echocardiographic two-dimensional speckle tracking imaging","volume":"11","author":"Ishizu","year":"2010","journal-title":"Eur. J. Echocardiogr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/ehjci\/jeu184","article-title":"Definitions for a common standard for 2D speckle tracking echocardiography: Consensus document of the EACVI\/ASE\/Industry Task Force to standardize deformation imaging","volume":"16","author":"Voigt","year":"2015","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1016\/j.echo.2007.08.023","article-title":"Relationship Between Ventricular Contractility and Early Diastolic Intraventricular Pressure Gradients: A Diastolic Link to Systolic Function","volume":"21","author":"Firstenberg","year":"2008","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1007\/s10554-020-01822-8","article-title":"Early diastolic strain rate by two-dimensional speckle tracking echocardiography is a predictor of coronary artery disease and cardiovascular events in stable angina pectoris","volume":"36","author":"Hagemann","year":"2020","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1016\/j.jcmg.2015.06.029","article-title":"Early Diastolic Strain Rate in Relation to Systolic and Diastolic Function and Prognosis in Aortic Stenosis","volume":"9","author":"Dahl","year":"2016","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1093\/eurheartj\/eht179","article-title":"Early diastolic strain rate in relation to systolic and diastolic function and prognosis in acute myocardial infarction: A two-dimensional speckle-tracking study","volume":"35","author":"Andersen","year":"2014","journal-title":"Eur. Heart J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1093\/ehjci\/jes139","article-title":"Altered left ventricular longitudinal diastolic function correlates with reduced systolic function immediately after anthracycline chemotherapy","volume":"14","author":"Stoodley","year":"2013","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Mutter, R.W., Giri, S., Fruth, B.F., Remmes, N.B., Boughey, J.C., Harless, C.A., Ruddy, K.J., McGee, L.A., Afzal, A., and Gao, R.W. (Lancet Oncol., 2023). Conventional versus hypofractionated postmastectomy proton radiotherapy in the USA (MC1631): A randomised phase 2 trial, Lancet Oncol., Online ahead of print.","DOI":"10.1016\/S1470-2045(23)00388-1"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/S0360-3016(02)02754-2","article-title":"Relative biological effectiveness (RBE) values for proton beam therapy","volume":"53","author":"Paganetti","year":"2002","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1093\/ehjci\/jev014","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"16","author":"Lang","year":"2015","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1321","DOI":"10.1093\/ehjci\/jew082","article-title":"Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"17","author":"Nagueh","year":"2016","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1093\/ehjci\/jeu192","article-title":"Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: A report from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"15","author":"Plana","year":"2014","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Gao, R.W., Mullikin, T.C., Aziz, K.A., Afzal, A., Smith, N.L., Routman, D.M., Gergelis, K.R., Harmsen, W.S., Remmes, N.B., and Tseung, H. (Int. J. Radiat. Oncol. Biol. Phys., 2023). Postmastectomy Intensity Modulated Proton Therapy: 5-Year Oncologic and Patient-Reported Outcomes, Int. J. Radiat. Oncol. Biol. Phys., Online ahead of print.","DOI":"10.1016\/j.ijrobp.2023.05.036"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e243","DOI":"10.1016\/j.prro.2016.12.002","article-title":"Initial clinical experience of postmastectomy intensity modulated proton therapy in patients with breast expanders with metallic ports","volume":"7","author":"Mutter","year":"2017","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1016\/0002-9149(85)90409-6","article-title":"Early cardiac changes related to radiation therapy","volume":"56","author":"Ikaheimo","year":"1985","journal-title":"Am. J. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1016\/j.ijrobp.2012.09.022","article-title":"Subclinical cardiotoxicity detected by strain rate imaging up to 14 months after breast radiation therapy","volume":"85","author":"Erven","year":"2013","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e019476","DOI":"10.1161\/JAHA.120.019476","article-title":"Segmental Cardiac Radiation Dose Determines Magnitude of Regional Cardiac Dysfunction","volume":"10","author":"Trivedi","year":"2021","journal-title":"J. Am. Heart Assoc."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.1016\/j.ijrobp.2010.01.004","article-title":"Acute radiation effects on cardiac function detected by strain rate imaging in breast cancer patients","volume":"79","author":"Erven","year":"2011","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1016\/j.ijrobp.2020.12.008","article-title":"Early Cardiac Effects of Contemporary Radiation Therapy in Patients With Breast Cancer","volume":"109","author":"Clasen","year":"2021","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.ijrobp.2014.11.016","article-title":"Subclinical cardiac dysfunction detected by strain imaging during breast irradiation with persistent changes 6 weeks after treatment","volume":"92","author":"Lo","year":"2015","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1093\/ehjci\/jex185","article-title":"Lower limit of normality and clinical relevance of left ventricular early diastolic strain rate for the detection of left ventricular diastolic dysfunction","volume":"19","author":"Morris","year":"2018","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1016\/j.ijrobp.2015.11.049","article-title":"Deep Inspiration Breath Hold-Based Radiation Therapy: A Clinical Review","volume":"94","author":"Knopf","year":"2016","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1016\/S0360-3016(02)04143-3","article-title":"Significant reductions in heart and lung doses using deep inspiration breath hold with active breathing control and intensity-modulated radiation therapy for patients treated with locoregional breast irradiation","volume":"55","author":"Remouchamps","year":"2003","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1641","DOI":"10.1200\/JCO.2016.72.0722","article-title":"Estimating the Risks of Breast Cancer Radiotherapy: Evidence From Modern Radiation Doses to the Lungs and Heart and From Previous Randomized Trials","volume":"35","author":"Taylor","year":"2017","journal-title":"J. Clin. Oncol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e71","DOI":"10.1016\/j.prro.2019.08.011","article-title":"Incorporation of Biologic Response Variance Modeling Into the Clinic: Limiting Risk of Brachial Plexopathy and Other Late Effects of Breast Cancer Proton Beam Therapy","volume":"10","author":"Mutter","year":"2020","journal-title":"Pract. Radiat. Oncol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1016\/j.ijrobp.2018.03.037","article-title":"Asymptomatic Late-phase Radiographic Changes Among Chest-Wall Patients Are Associated With a Proton RBE Exceeding 1.1","volume":"101","author":"Underwood","year":"2018","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.ijrobp.2021.05.110","article-title":"Proton Therapy for Breast Cancer: A Consensus Statement From the Particle Therapy Cooperative Group Breast Cancer Subcommittee","volume":"111","author":"Mutter","year":"2021","journal-title":"Int. J. Radiat. Oncol. Biol. Phys."}],"container-title":["Journal of Cardiovascular Development and Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2308-3425\/10\/10\/418\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:05:01Z","timestamp":1760130301000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2308-3425\/10\/10\/418"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,4]]},"references-count":37,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["jcdd10100418"],"URL":"https:\/\/doi.org\/10.3390\/jcdd10100418","relation":{},"ISSN":["2308-3425"],"issn-type":[{"type":"electronic","value":"2308-3425"}],"subject":[],"published":{"date-parts":[[2023,10,4]]}}}