PMC10154576_01
Two-dimensional transthoracic echocardiography 1 week before the radiotherapy course (A-F), illustrating the normal thickness of the left and right ventricular walls, in addition to global mild left ventricular systolic dysfunction: (A) PLAX view. (B) PSAX in the end-diastole. (C) PSAX in the end-systole. (D) A4C view in the end-diastole. (E) A4C view in the end-systole. (F) LV EF = 42% by Simpson's method. PLAX, parasternal long axis view; PSAX, parasternal short axis view; A4C, apical four chamber view.
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F1
Before mastectomy, TTE evaluation (performed for estimation of surgical risk) showed an LV EF of 42% and a global longitudinal strain (GLS) of -18.2% (Figures 1, 2A) with mild ischemia in the apex on SPECT.
Speckle tracking echocardiography before and after the radiotherapy course: (A) Before radiotherapy, which showed a global longitudinal strain of -18.2% with myocardial performance impairment in the bases of inferior, septal, and anteroseptal walls a week. (B) After radiotherapy, which showed GLS: -11.2% with evidence of severe myocardial performance impairment accompanied by relative apical sparing.
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F2
Before mastectomy, TTE evaluation (performed for estimation of surgical risk) showed an LV EF of 42% and a global longitudinal strain (GLS) of -18.2% (Figures 1, 2A) with mild ischemia in the apex on SPECT. LV EF to 29% (from 42%) and GLS to -11.2% (from 18.2%, Figures 2B, 3). LV EF was measured by 2D TTE and was calculated using
Two-dimensional transthoracic echocardiography 1 month after the radiotherapy course (A-F), illustrating a marked increase in the thickness of the left and right ventricular walls (15 and 7 mms, respectively), in addition to severe left ventricular systolic dysfunction. (A) PLAX view. (B) PSAX in the end-diastole. (C) PSAX in the end-systole. (D) A4C view in the end-diastole. (E) A4C view in the end-systole. (F) LV EF = 28% by Simpson's method. PLAX, parasternal long axis view; PSAX, parasternal short axis view; A4C, apical four chamber view.
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F3
LV EF to 29% (from 42%) and GLS to -11.2% (from 18.2%, Figures 2B, 3). LV EF was measured by 2D TTE and was calculated using
The results of cardiac magnetic resonance imaging after the radiation (A-D). (A) T2 analysis of mid-septal and mid-lateral segments of the left ventricle revealed prolongation of T2 relaxation time in the mid to apical segments of the lateral wall (52 ms). (B) T2 map image of the left ventricle in short axis view showed abnormal T2 value in the mid-lateral segment of the left ventricle. (C) Delayed postcontrast image of the left ventricle in short axis view showed a subepicardial rim of late gadolinium enhancement on the lateral wall of the left ventricle. (D) Delayed postcontrast image of the left ventricle in long axis three-chamber axis view revealed small focal subepicardial to mid-wall patches of late gadolinium enhancement in the basal inferolateral segment.
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F4
T2-weighted image (T2WI), T2 mapping, native and postcontrast T1 mapping, and delayed postcontrast images. The results of CMR showed diffuse myocardial inflammation in T1 mapping and extracellular volume (ECV) map of LV, mid-wall late gadolinium enhancement (LGE) in basal segments of the interventricular septum (IVS), and subepicardial delayed enhancement in the basal inferolateral segments of LV without an ischemic pattern of myocardial injury (Figure 4). The regions marked as LGE on