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Left Ventricular Function Assessed by Two-Dimensional Speckle Tracking Echocardiography in Long-Term Survivors of Hodgkin's Lymphoma Treated by Mediastinal Radiotherapy With or Without Anthracycline Therapy

https://doi.org/10.1016/j.amjcard.2010.09.048Get rights and content

Anthracycline therapy is well known for its adverse cardiac effects. However, few studies have been performed of the long-term follow-up of myocardial function in adult survivors of Hodgkin's lymphoma receiving anthracycline. Two-dimensional speckle tracking echocardiography is an accurate angle-independent modality for the quantification of left ventricular (LV) function. The aim of the present study was to investigate the long-term effect of anthracycline on LV systolic function. Echocardiography was performed in 47 survivors of Hodgkin's lymphoma 22 ± 2 years after successful mediastinal radiotherapy with (n = 27) or without (n = 20) anthracycline (doxorubicin) treatment and in 20 healthy controls. LV function was assessed by the LV ejection fraction and global longitudinal and circumferential strain. Both patient groups had received a similar dosage of radiation, and doxorubicin was given at a total dose of 309 ± 92 mg. The global longitudinal strain was reduced in patients receiving anthracycline with mediastinal radiotherapy compared to the other group receiving mediastinal radiotherapy alone or combined radiotherapy and regimens without anthracyclines (−16.1 ± 1.9% vs −17.5 ± 1.7%, respectively, p <0.05). Both patient groups had reduced strain compared to the healthy controls (−20.4 ± 1.7%, both p <0.001). The circumferential strain was also reduced in the treatment groups (−18.3 ± 3.2% and −17.8 ± 3.6% vs −22.5 ± 2.1%, both p <0.001). The LV ejection fraction did not differ between the patient groups (55 ± 8% vs 56 ± 6%, p = 1.0) but was reduced compared to that of the controls (62 ± 5%, both p <0.05). In conclusion, myocardial function was reduced in the survivors of Hodgkin's lymphoma 2 decades after successful treatment consisting of mediastinal radiotherapy with or without chemotherapy. Patients receiving anthracycline therapy had additional negative long-tem effects on LV systolic function.

Section snippets

Methods

A total of 47 long-term survivors of Hodgkin's lymphoma (51 ± 9 years old) were divided into 2 groups according to previous lymphoma treatment either with or without anthracyclines at the Oslo University Hospital (The Norwegian Radium Hospital, Oslo, Norway) between 1980 and 1988. All patients had also undergone mediastinal radiotherapy. Additional details regarding patient selection and treatment have been published in our previous study of valvular dysfunction in survivors of Hodgkin's

Results

Both Hodgkin's lymphoma survivor groups had received a similar radiation dosage (Table 1). No significant differences were found in the demographic characteristics between those who had or had not received anthracycline (Table 1). Both patient groups were comparable with the healthy subjects in terms of age, although the heart rate was greater in the patient groups.

The patients who had received anthracycline and mediastinal radiotherapy had a significantly reduced global longitudinal strain

Discussion

The results of the present study have demonstrated a persistent decrease in LV function among the survivors of Hodgkin's lymphoma who had undergone mediastinal radiotherapy with or without additional chemotherapy more than 2 decades earlier. Our quantitative results have confirmed that anthracycline treatment deteriorates radiation-associated myocardial dysfunction in the long term.

Anthracyclines are effective antineoplastic agents used for a wide spectrum of hematologic malignancies and solid

References (29)

  • J.L. Hare et al.

    Use of myocardial deformation imaging to detect preclinical myocardial dysfunction before conventional measures in patients undergoing breast cancer treatment with trastuzumab

    Am Heart J

    (2009)
  • S.D. Solomon et al.

    Influence of ejection fraction on cardiovascular outcomes in a broad spectrum of heart failure patients

    Circulation

    (2005)
  • T.G. Neilan et al.

    Tissue Doppler imaging predicts left ventricular dysfunction and mortality in a murine model of cardiac injury

    Eur Heart J

    (2006)
  • T.J. Wang et al.

    Natural history of asymptomatic left ventricular systolic dysfunction in the community

    Circulation

    (2003)
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    This work was supported by Madou Sin-Lau Hospital, the Presbyterian Church in Taiwan, the Inger and John Fredriksen Foundation, the South-Eastern Norway Regional Health Authority, and the Norwegian Research Council.

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