Assessment of Valvular Disorders in Survivors of Hodgkin's Lymphoma Treated by Mediastinal Radiotherapy ± Chemotherapy

• Published in: The American journal of cardiology 2016-02, Vol.117 (4), p.691-696
• Main Authors: Bijl, Jesse M., MD, Roos, Marleen M., MD, van Leeuwen-Segarceanu, Elena M., MD, PhD, Vos, Josephine M., MD, Bos, Willem-Jan W., MD, PhD, Biesma, Douwe H., MD, PhD, Post, Marco C., MD, PhD
• Format: Article
• Language: English
• Subjects: Adult; Age; Aged; Antineoplastic Agents - adverse effects; Antineoplastic Agents - therapeutic use; Blood pressure; Cardiology; Cardiovascular; Cardiovascular disease; Chemoradiotherapy - adverse effects; Chemotherapy; Cholesterol; Cross-Sectional Studies; Dose-Response Relationship, Drug; Dose-Response Relationship, Radiation; Female; Follow-Up Studies; Heart Valve Diseases - epidemiology; Heart Valve Diseases - etiology; Hodgkin Disease - complications; Hodgkin Disease - mortality; Hodgkin Disease - therapy; Humans; Hypertension; Lymphatic system; Male; Mediastinum; Middle Aged; Mortality; Multivariate analysis; Netherlands - epidemiology; Patients; Prognosis; Radiation therapy; Retrospective Studies; Risk Factors; Studies; Survival Rate - trends; Variables; Young Adult
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2015.11.027

As the number of Hodgkin's lymphoma (HL) survivors grows, understanding long-term complications becomes more important. Mediastinal radiotherapy (MRT) seems to cause valvular disease, and the prevalence might increase during follow-up. In this cross-sectional study 82 HL survivors participated (52% men, mean age 47.8 years, 50 treated with MRT). Valvular disease was diagnosed by transthoracic echocardiography and compared between HL survivors treated with and without MRT. Univariate and multivariate logistic regression analysis was used to identify predictors for valvular disease. During a median follow-up of 13.4 years (range 2 to 39 years), ≥ mild valvular disease was present in 61.2% of HL survivors with MRT (n = 30), compared with 31.0% of HL survivors without MRT (n = 9; odds ratio [OR] 3.51, 95% CI 1.32 to 9.30, p = 0.01). In multivariate analysis, only current age remained predictive for ≥ mild valvular disease (OR 1.08 per year, 95% CI 1.01 to 1.14, p = 0.023). Aortic regurgitation (AR) was most prevalent and irradiated patients had significantly more ≥ mild AR (38.2% vs 6.8%, p = 0.007). Within the MRT subgroup, time after radiation of >15 years was associated with AR (OR 4.70, 95% CI 1.05 to 21.03, p = 0.043), after adjusting for current age and hypertension. Severe valvular disease was present in 24.5% of HL survivors with MRT compared with 3.4% without MRT (p = 0.016). Valvular surgery was performed in 9 HL survivors (18.0%) with MRT and in none without MRT. In conclusion, the prevalence of valvular disease in HL survivors treated with MRT is high and increases with time after irradiation. Long-time screening for valvular disease by transthoracic echocardiography might be worthwhile.