Characterization of cardiovascular injury in mice following partial-heart irradiation with clinically relevant dose and fractionation

Background and purpose: Late cardiac toxicity is a major side effect of radiation therapy (RT) for breast cancer. We developed and characterized a mouse model of radiation-induced heart disease that mimics the dose, fractionation, and beam arrangement of left breast and chest wall RT. Material and methods: Female wild-type (C57BL6/J) and atherosclerosis-prone apolipoprotein E-deficient (ApoE(-/-)) mice (on a C57BL/6J background) on regular chow were treated with 2 Gy x 25 fractions of partial-heart irradiation via opposed tangential beams to the left chest wall. The changes in myocardial perfusion and cardiac function of C57BL/6J mice were examined by single-photon emission computed tomography (SPECT) and echocardiography, respectively. In addition to SPECT and echocardiography, the formation of calcified plaques and changes in cardiac function of ApoE(-/-)mice were examined by dual-energy microCT (DE-CT) and pressure-volume (PV) loop analysis, respectively. The development of myocardial fibrosis was examined by histopathology. Results: Compared to unirradiated controls, irradiated C57BL/6J mice showed no significant changes by SPECT or echocardiography up to 18 months after 2 Gy x 25 partial-heart irradiation even though irradiated mice exhibited a modest increase in myocardial fibrosis. For ApoE(-/-) mice, 2 Gy x 25 partial-heart irradiation did not cause significant changes by SPECT, DE-CT, or echocardiography. However, PV loop analysis revealed a significant decrease in load-dependent systolic and diastolic function measures including cardiac output, dV/dtmax and dV/dt min 12 months after RT. Conclusions: Following clinically relevant doses of partial-heart irradiation in C57BL/6J and ApoE(-/-)mice, assessment with noninvasive imaging modalities such as echocardiography, SPECT, and DE-CT yielded no evidence of decreased myocardial perfusion and cardiac dysfunction related to RT. However, invasive hemodynamic assessment with PV loop analysis indicated subtle, but significant, changes in cardiac function of irradiated ApoE(-/-) mice. PV loop analysis may be useful for future preclinical studies of radiation induced heart disease, especially if subtle changes in cardiac function are expected. (C) 2021 Elsevier B.V. All rights reserved.

Automated summary

A mouse model of radiation-induced heart disease simulating RT for breast cancer was developed. Noninvasive imaging modalities found no evidence of decreased myocardial perfusion and cardiac dysfunction, but PV loop analysis revealed subtle changes in cardiac function in ApoE(-/-) mice. PV loop analysis may be useful for future preclinical studies of radiation-induced heart disease.