Left Ventricular Function in Long-Term Survivors of Childhood Lymphoma

Survivors of childhood lymphoma (CL) have markedly increased risk of developing heart failure. Echocardiographic studies after cardiotoxic treatment have primarily demonstrated left ventricular (LV) systolic dysfunction. In the present study, we hypothesized that longer follow-up and a more comprehe...

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Published in:The American journal of cardiology 2014-08, Vol.114 (3), p.483-490
Main Authors: Christiansen, Jon R., MD, Hamre, Hanne, MD, PhD, Massey, Richard, MSc, Dalen, Håvard, MD, PhD, Beitnes, Jan O., MD, PhD, Fosså, Sophie D., MD, PhD, Kiserud, Cecilie E., MD, PhD, Aakhus, Svend, MD, PhD
Format: Article
Language:English
Subjects:
Adolescent
Adult
Age
Cardiology
Cardiovascular
Child
Drug therapy
Echocardiography
Female
Forecasting
Humans
Lymphoma - diagnostic imaging
Lymphoma - mortality
Lymphoma - physiopathology
Male
Medical research
Methods
Middle Aged
Norway - epidemiology
Radiation therapy
Registries
Retrospective Studies
Studies
Surveys and Questionnaires
Survival Rate - trends
Survivors - statistics & numerical data
Veins & arteries
Ventricular Function, Left - physiology
Young Adult
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creator Christiansen, Jon R., MD
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Kiserud, Cecilie E., MD, PhD
Aakhus, Svend, MD, PhD
description Survivors of childhood lymphoma (CL) have markedly increased risk of developing heart failure. Echocardiographic studies after cardiotoxic treatment have primarily demonstrated left ventricular (LV) systolic dysfunction. In the present study, we hypothesized that longer follow-up and a more comprehensive echocardiographic examination would reveal more cardiac abnormalities. We conducted a cross-sectional study with echocardiography 20.4 ± 8.6 years after diagnosis in 125 survivors of CL, grouped according to treatment methods, and compared with matched controls. Treatment included mediastinal radiotherapy (median 40.0 Gy) in 66 and anthracyclines (median dose 160 mg/m2 ) in 92 survivors of CL. Abnormal LV function, left-sided valve dysfunction, or both occurred in 62 patients (50%). Diastolic dysfunction occurred in 29%. Compared with control subjects, mitral annular early diastolic velocities (e′) were reduced in patients (septal e′ 0.09 ± 0.03 vs 0.12 ± 0.03 m/s, p
doi_str_mv 10.1016/j.amjcard.2014.04.055
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Echocardiographic studies after cardiotoxic treatment have primarily demonstrated left ventricular (LV) systolic dysfunction. In the present study, we hypothesized that longer follow-up and a more comprehensive echocardiographic examination would reveal more cardiac abnormalities. We conducted a cross-sectional study with echocardiography 20.4 ± 8.6 years after diagnosis in 125 survivors of CL, grouped according to treatment methods, and compared with matched controls. Treatment included mediastinal radiotherapy (median 40.0 Gy) in 66 and anthracyclines (median dose 160 mg/m2 ) in 92 survivors of CL. Abnormal LV function, left-sided valve dysfunction, or both occurred in 62 patients (50%). Diastolic dysfunction occurred in 29%. Compared with control subjects, mitral annular early diastolic velocities (e′) were reduced in patients (septal e′ 0.09 ± 0.03 vs 0.12 ± 0.03 m/s, p &lt;0.001), and the E/e′ ratio was increased, particularly after mediastinal radiotherapy (10.6 ± 6.4 vs 5.6 ± 1.3, p &lt;0.001). Survivors of CL had lower fractional shortening than control subjects (32 ± 6 vs 36 ± 7, p &lt;0.001), but mean ejection fraction was equal and overt systolic dysfunction was infrequent. After mediastinal radiotherapy alone, global longitudinal myocardial strain was lower (p &lt;0.05) compared with other treatment groups. Left-sided valvular dysfunction occurred in 55% of patients after mediastinal radiotherapy. In conclusion, survivors of CL had reduced LV diastolic function assessed by tissue Doppler imaging. This was more pronounced after mediastinal radiotherapy, which also frequently led to valvular disease. 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All rights reserved.</rights><rights>Copyright Elsevier Limited Aug 1, 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c518t-23f487bb55cb5b94f55931f98e77f457408124c8ea924519c27068384c4083613</citedby><cites>FETCH-LOGICAL-c518t-23f487bb55cb5b94f55931f98e77f457408124c8ea924519c27068384c4083613</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24948492$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Christiansen, Jon R., MD</creatorcontrib><creatorcontrib>Hamre, Hanne, MD, PhD</creatorcontrib><creatorcontrib>Massey, Richard, MSc</creatorcontrib><creatorcontrib>Dalen, Håvard, MD, PhD</creatorcontrib><creatorcontrib>Beitnes, Jan O., MD, PhD</creatorcontrib><creatorcontrib>Fosså, Sophie D., MD, PhD</creatorcontrib><creatorcontrib>Kiserud, Cecilie E., MD, PhD</creatorcontrib><creatorcontrib>Aakhus, Svend, MD, PhD</creatorcontrib><title>Left Ventricular Function in Long-Term Survivors of Childhood Lymphoma</title><title>The American journal of cardiology</title><addtitle>Am J Cardiol</addtitle><description>Survivors of childhood lymphoma (CL) have markedly increased risk of developing heart failure. 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Compared with control subjects, mitral annular early diastolic velocities (e′) were reduced in patients (septal e′ 0.09 ± 0.03 vs 0.12 ± 0.03 m/s, p &lt;0.001), and the E/e′ ratio was increased, particularly after mediastinal radiotherapy (10.6 ± 6.4 vs 5.6 ± 1.3, p &lt;0.001). Survivors of CL had lower fractional shortening than control subjects (32 ± 6 vs 36 ± 7, p &lt;0.001), but mean ejection fraction was equal and overt systolic dysfunction was infrequent. After mediastinal radiotherapy alone, global longitudinal myocardial strain was lower (p &lt;0.05) compared with other treatment groups. Left-sided valvular dysfunction occurred in 55% of patients after mediastinal radiotherapy. In conclusion, survivors of CL had reduced LV diastolic function assessed by tissue Doppler imaging. This was more pronounced after mediastinal radiotherapy, which also frequently led to valvular disease. 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Compared with control subjects, mitral annular early diastolic velocities (e′) were reduced in patients (septal e′ 0.09 ± 0.03 vs 0.12 ± 0.03 m/s, p &lt;0.001), and the E/e′ ratio was increased, particularly after mediastinal radiotherapy (10.6 ± 6.4 vs 5.6 ± 1.3, p &lt;0.001). Survivors of CL had lower fractional shortening than control subjects (32 ± 6 vs 36 ± 7, p &lt;0.001), but mean ejection fraction was equal and overt systolic dysfunction was infrequent. After mediastinal radiotherapy alone, global longitudinal myocardial strain was lower (p &lt;0.05) compared with other treatment groups. Left-sided valvular dysfunction occurred in 55% of patients after mediastinal radiotherapy. In conclusion, survivors of CL had reduced LV diastolic function assessed by tissue Doppler imaging. This was more pronounced after mediastinal radiotherapy, which also frequently led to valvular disease. Systolic function was normal in most survivors of CL.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>24948492</pmid><doi>10.1016/j.amjcard.2014.04.055</doi><tpages>8</tpages></addata></record>
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subjects Adolescent
Adult
Age
Cardiology
Cardiovascular
Child
Drug therapy
Echocardiography
Female
Forecasting
Humans
Lymphoma - diagnostic imaging
Lymphoma - mortality
Lymphoma - physiopathology
Male
Medical research
Methods
Middle Aged
Norway - epidemiology
Radiation therapy
Registries
Retrospective Studies
Studies
Surveys and Questionnaires
Survival Rate - trends
Survivors - statistics & numerical data
Veins & arteries
Ventricular Function, Left - physiology
Young Adult
title Left Ventricular Function in Long-Term Survivors of Childhood Lymphoma
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