• A Meta-Analysis of the Radiotherapy Impact on Cardiac Magnetic Resonance Imaging Findings
  • Sina Shahshenas,1 Masood Soltanipur,2,*
    1. Student Research Committee, Faculty of Medicine, Shahed University, Tehran, Iran
    2. General Practitioner (GP), Ebne-sina Medical Center (EMC), Tehran, Iran.


  • Introduction: Recent advances in cancer treatment have significantly improved survival rates; however, the side effects associated with therapies, particularly those involving radiotherapy (RT) and chemoradiotherapy (CRT), raise serious concerns regarding cardiovascular toxicity. This meta-analysis aimed to evaluate the structural and functional cardiac changes induced by RT using cardiac magnetic resonance imaging (CMR).
  • Methods: A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science databases through March 2025. Studies included in this analysis involved adult patients undergoing RT or CRT, with cardiac assessments performed by CMR both pre- and post-treatment, or compared with control groups. Extracted data encompassed study characteristics, treatment protocols, and changes in key cardiac parameters including left ventricular volumes, left ventricular ejection fraction (LVEF), left ventricular wall mass index, and myocardial strain indices. In addition, tissue characterization metrics such as T1, T2, and extracellular volume were evaluated.
  • Results: Thirteen studies comprising 544 individuals were included in the meta-analysis. Within-group analysis indicated that while overall changes in LVEF were not significant in the total population, a significant reduction was observed in the CRT subgroup. Both RT and CRT subgroups demonstrated a significant reduction in left ventricular end-diastolic volume index, suggesting a potential RT-induced remodelling effect on the heart leading to decreased ventricular filling. Notably, CRT patients exhibited a significant increase in left ventricular end-systolic volume index, in contrast to a non-significant decrease in RT patients. Furthermore, reductions in global radial strain (GRS) were more significant in the CRT group compared to the RT group. Significant increases in T1 mapping values, especially in RT patients, suggest early fibrotic or inflammatory myocardial changes.
  • Conclusion: These findings underscore that RT is associated with significant structural and functional alterations in the heart. The observed decreases in left ventricular volume indices and myocardial strain, along with early tissue alterations as indicated by increased T1 values, highlight the importance of regular cardiac monitoring in patients undergoing these therapies.
  • Keywords: Radiotherapy; Chemoradiotherapy; Cardiotoxicity; Cardiac Magnetic Resonance Imaging