The impact of radioactive iodine treatment on subclinical left ventricular dysfunction in patients treated for differentiated thyroid cancer: assessing the predictive value of presystolic wave

Abstract

Objectives: Despite strong evidence regarding the impact of radioactive iodine (RAI) on the hematopoietic, genitourinary, and gastrointestinal systems, its role in the cardiovascular system needs to be clarified. We hypothesized that the presence of a presystolic wave could be predictive for cardiovascular dysfunction in subjects receiving RAI. Thus, we investigated presystolic wave presence in differentiated thyroid cancer (DTC) patients with and without RAI therapy after undergoing total thyroidectomy.

Methods: Patients were included in the study within 1-5 years after thyroidectomy or thyroidectomy and RAI treatment. Participants were divided into three groups as follows: the first group included patients with DTC who received RAI following total thyroidectomy (Group 1; n = 33), the second group included patients with DTC who did not receive RAI following total thyroidectomy (Group 2; n = 34). The third group of age-matched subjects who underwent total thyroidectomy with suspicion of DTC and resulted in benign pathologies was also selected (Group 3; n = 37). All subjects underwent transthoracic echocardiography. The presence of a presystolic wave was assessed with Doppler imaging of the left ventricular outflow tract.

Results: Presystolic wave was more common in subjects receiving RAI (Group 1) compared to Group 2 (those without RAI) (90.9% vs. 61.8% respectively, p = 0.003), and its prevalence in Group 3 was 54.1%. Multiple logistic regression analysis revealed that receiving RAI (OR: 4.922, 95% CI: 1.640 – 20.022, p = 0.004) was independently associated with a 5-fold higher risk for the presence of a presystolic wave.

Conclusions: RAI following total thyroidectomy in patients with DTC is associated with a five-fold increase in the presence of the presystolic wave, as a proxy marker for subclinical left ventricular dysfunction.

Keywords

• Differentiated thyroid cancer
• radioactive iodine
• echocardiography
• presystolic wave

References

1. 1. Busaidy NL, Cabanillas ME. Differentiated thyroid cancer: management of patients with radioiodine nonresponsive disease. J Thyroid Res 2012;2012:618985.
2. 2. Tuttle RM. Controversial issues in thyroid cancer management. J Nucl Med 2018;59:1187-94.
3. 3. Pace-Asciak P, Russell JO, Tufano RP. The treatment of thyroid cancer with radiofrequency ablation. Tech Vasc Interv Radiol 2022;25:100825.
4. 4. Fard-Esfahani A, Emami-Ardekani A, Fallahi B, Fard-Esfahani P, Beiki D, Hassanzadeh-Rad A, et al. Adverse effects of radioactive iodine-131 treatment for differentiated thyroid carcinoma. Nucl Med Commun 2014;35:808-17.
5. 5. Soloviev AI, Kizub IV. Mechanisms of vascular dysfunction evoked by ionizing radiation and possible targets for its pharmacological correction. Biochem Pharmacol 2019;159:121-39.
6. 6. Akyüz AR, Turan T, Gürbak İ, Korkmaz L, Ağaç MT, Çelik Ş. The relationship between presystolic wave and subclinical left ventricular dysfunction in asymptomatic hypertensive patients. Blood Press Monit 2016;21:277-81.
7. 7. Kul S, Dursun İ, Ayhan S, Sayin MR, Üçüncü Ö, Bülbül NE, et al. Presystolic wave is associated with subclinical left ventricular dysfunction assessed by myocardial performance index in type 2 diabetes mellitus. Arq Bras Cardiol 2019;113:207-15.
8. 8. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005;18:1440-63.

9. 9. Nian M, Lee P, Khaper N, Liu P. Inflammatory cytokines and postmyocardial infarction remodeling. Circ Res 2004;94:1543-53.
10. 10. Baselet B, Rombouts C, Benotmane AM, Baatout S, Aerts A. Cardiovascular diseases related to ionizing radiation: the risk of low-dose exposure (review). Int J Mol Med 2016;38:1623-41.
11. 11. Puukila S, Lemon JA, Lees SJ, Tai TC, Boreham DR, Khaper N. Impact of ionizing radiation on the cardiovascular system: a review. Radiat Res 2017;188:539-46.
12. 12. Schaue D, Micewicz ED, Ratikan JA, Xie MW, Cheng G, McBride WH. Radiation and inflammation. Semin Radiat Oncol 2015;25:4-10.
13. 13. Darby SC, Cutter DJ, Boerma M, Constine LS, Fajardo LF, Kodama K, et al. Radiation-related heart disease: current knowledge and future prospects. Int J Radiat Oncol Biol Phys 2010;76:656-65.
14. 14. Şaylık F, Akbulut T. A presystolic wave could easily detect subclinical left ventricular dysfunction in prediabetic patients with no history of hypertension. Echocardiography 2022;39:74-81.
15. 15. Demiröz Ö, Öztürkeri B. The relationship of left ventricular outflow tract presystolic wave and 24-h ambulatory blood pressure measurements. Blood Press Monit 2022;27:378-83.
16. 16. Kahyaoglu M, Bayam E, Gunay N, Gecmen C, Candan O, Yilmaz Y, et al. The relationship between presystolic wave and nondipper hypertension. Blood Press Monit 2020;25:142-6.
17. 17. Korkmaz L, Akyüz AR, Gurbak I, Erkan H, Dursun I, Celik S. Presystolic A wave may predict increased arterial stiffness in asymptomatic individuals. Blood Press Monit 2016;21:144-8.
18. 18. Alimi H, Hamidi F, Bigdelue L, Poorzand H, Ghaderi F, Fazlinejad A, et al. Prevalence of the presystolic wave in echocardiography and its association with the extent of coronary artery disease in patients with chronic stable angina. Echocardiography 2021;38:745-51.
19. 19. Dursun I, Kul S, Sahin S, Kalaycioglu E, Akyuz AR, Korkmaz L. Relation of presystolic wave on doppler examination to syntax score in patients with acute myocardial infarction. Int J Cardiovasc Imaging 2018;34:569-76.
20. 20. Saylik F, Akbulut T. The association of presystolic wave with subclinical left-ventricular dysfunction in patients with subclinical hypothyroidism. J Echocardiogr 2022;20:97-105.
21. 21. Stanciu AE, Stanciu MM, Zamfirescu A, Gheorghe DC. Cardiovascular effects of cumulative doses of radioiodine in differentiated thyroid cancer patients with type 2 diabetes mellitus. Cancers (Basel) 2022;14:2359.