Late cardiac effects after mantle radiotherapy in patients with Hodgkin's disease.
Twenty-five patients (21-45 years old) treated for Hodgkin's disease with mantle radiotherapy but no chemotherapy underwent cardiac testing with myocardial scintigraphy during exercise, Echo-Doppler cardiography and CT-examination, 10-20 years after treatment. Four of twenty-six (15%) young patients had serious cardiac complications after mantle therapy, and reduced systolic and/or diastolic function; and minor valvular disturbances were often found. One 36-year-old female died of myocardial infarction 4 years after therapy, one 39-year-old male had two non-lethal infarctions after 14 years, one 36-year-old male with no symptoms had severe reversible ischemia and three proximal coronary artery stenoses, and one 32-year-old female with constrictive pericarditis had pericardeictomy 14 years after therapy. In 23/24 patients the pericardial thickness was normal and no pericardial effusion was found. 23/24 patients had normal working capacity, but myocardial scintigraphy was normal in only 9 patients. 11/25 patients had reduced systolic function and in 12/24 patients the diastolic function was reduced. 11/25 patients had abnormal valvular or subvalvular structures. Valvular stenosis was not found but aortic, mitral and tricuspidal regurgitations were found in 1/25, 9/25 and 22/25, respectively. In all but two cases the regurgitations were mild. We conclude that mediastinal irradiation must be considered a risk factor for cardiac disease. It may be advisable to reduce other risk factors in these patients.
Gustavsson
A
A
Department of Oncology, University Hospital, Lund, Sweden.
Eskilsson
J
J
Landberg
T
T
Svahn-Tapper
G
G
White
T
T
Wollmer
P
P
Akerman
M
M
D000328:Adult; D006328:Cardiac Catheterization; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000528:radiation effects*; D006331:Heart Diseases / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D006689:Hodgkin Disease / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D011832:Radiation Injuries / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D012307:Risk Factors; D015996:Survival Rate; D013972:Thyrotropin / Q000097:blood; D014057:Tomography, X-Ray Computed
D013972:Thyrotropin