Early Altered Left Heart Function In Non-Operative Advanced Distal Esophageal Cancer Patients Treated With Concurrent Chemoradiotherapy: A Single Institutional Retrospective Analysis

In this study, we retrospectively evaluate early impairment of left heart function assessed by tissue Doppler imaging (TDI) in patients with non-operative advanced distal esophageal cancer after concurrent chemoradiotherapy (CCRT). The left heart functions of 40 patients with inoperative advanced distal esophageal cancer who received CCRT were evaluated before and after CCRT. And the parameters related to left ventricular ejection fraction (LVEF), the peak early (E) and late (A) mitral inflow velocities and E/A ratio, the parameters related to the peak systolic wave Sm, early (Em) and late (Am) mitral annular velocities, E/Em and Em/Am ratios detected by TDI and left atrial volume index (LAVI) were also compared. After CCRT, there were no patients with pericardial effusion and valvular disease. There were marginally significant decrease in LVEF and peak E mitral inflow velocity and a significant increase in peak A mitral inflow velocity after CCRT, but the E/A ratio was not changed after CCRT. By using TDI examination, there were significant decreases in Sm, Em and Em/Am ratio and significant increases in Am and E/Em ratio after CCRT. The LAVI was significantly increased when compared with the one before CCRT. And there was a positive correlation between LAVI and E/Em ratio. Therefore, early heart toxicity as indicated by altered LAVI and LV diastolic function is detected after CCRT in patients with esophageal cancer. And the implementation of TDI technology can provide important information of LV impairment earlier than the standard echocardiography.