Diagnostic utility of 24-hour ambulatory electrocardiography combined with cardiac troponin T and creatine kinase-MB in assessing radiation-induced heart injury in patients with thoracic malignancies
Objective This study aimed to evaluate the diagnostic utility of combining 24-hour ambulatory electrocardiography(Holter monitoring)with cardiac troponin T(cTnT)and creatine kinase-MB(CK-MB)for assessing radiation-induced heart injury(RIHD)in patients undergoing chest radiotherapy.Methods We selected 116 patients with thoracic malignancies treated with radiotherapy at Hainan General Hospital Affiliated to Hainan Medical College from 2018 to 2022.They underwent routine electrocardiography,24-hour ambulatory electrocardiography,echocardiography,and serum levels of cTnT and CK-MB before radiotherapy,at the end of radiotherapy,and three months post-radiotherapy.Patients were categorized into RIHD and non-RIHD groups based on the presence of RIHD.We compared the cTnT and CK-MB levels,as well as the diagnostic value of individual and combined assessments of 24-hour ambulatory electrocardiography,cTnT,and CK-MB for RIHD.Results Prior to radiotherapy,there were no significant differences in cTnT[(0.185±0.028)μg∕L vs.(0.193±0.025)μg∕L]and CK-MB[(19.21±4.07)U∕L vs.(18.55±3.52)U∕L]levels between the RIHD and non-RIHD groups(t=1.579,1.913,P>0.05).However,the levels of cTnT and CK-MB at different time points(before,at the end of,and three months post-radiotherapy)showed significant differences(F=932.30,293.93,P<0.05).Post hoc LSD-t tests indicated that both groups had increased cTnT and CK-MB levels after radiotherapy and at three months,with the RIHD group showing higher levels than the non-RIHD group,which was statistically significant(P<0.05).At three months post-radiotherapy,the agreement between routine electrocardiography and clinical diagnosis was poor(Kappa=0.306,P<0.05),while 24-hour ambulatory electrocardiography,echocardiography,and individual tests of cTnT and CK-MB showed moderate agreement(Kappa=0.401,0.437,0.541,0.418,P<0.05).The combined assessment of 24-hour ambulatory electrocardiography,cTnT,and CK-MB demonstrated the best agreement(Kappa=0.796,P<0.05).The sensitivity,specificity,consistency,positive predictive value,and negative predictive value of the combined assessment were superior to those of individual tests.Conclusion The combination of 24-hour ambulatory electrocardiography with cTnT and CK-MB provides a reliable,accurate,and clinically feasible approach for assessing RIHD in patients with thoracic malignancies undergoing radiotherapy.
万方数据
