Cardiovascular status in long-term survivors of Hodgkin's disease treated with chest radiotherapy.
OBJECTIVE
Cardiovascular status was assessed in 48 Hodgkin's disease (HD) survivors at a median of 14.3 years (range, 5.9 to 27.5 years) after diagnosis because they may be at increased risk for cardiovascular abnormalities.


METHODS
Patients completed the Short-Form 36 quality-of-life instrument and were screened by echocardiography, exercise stress testing, and resting and 24-hour ECG.


RESULTS
All patients received mediastinal irradiation (median, 40.0 Gy; range, 27.0 to 51.7 Gy) at a median age of 16.5 years (range, 6.4 to 25.0 years). Four patients received an anthracycline. Although every patient described their health as good or better, and none had symptomatic heart disease at screening, all but one had cardiac abnormalities on screening. Restrictive cardiomyopathy was suggested by reduced average left ventricular (LV) dimension (P < .001) and mass (P < .001), without increased LV wall thickness. Significant valvular defects were present in 42%; 75% had conduction defects. One survivor developed complete heart block shortly after the study visit. Autonomic dysfunction was suggested by a monotonous heart rate in 57%, persistent tachycardia in 31%, and blunted hemodynamic responses to exercise in 27%. Peak oxygen uptake (VO2max) during exercise, a predictor of mortality in heart failure, was significantly reduced (< 20 mL/kg/m2) in 30% of survivors. VO2max was correlated with increasing fatigue, increasing shortness of breath (both, r = -0.35; P =. 02), and decreasing physical component score on the SF-36 (r = 0.554; P = .00017).


CONCLUSIONS
A variety of unsuspected, clinically significant cardiovascular abnormalities are common in long-term survivors of HD who are treated at a young age with mediastinal irradiation. We recommend serial, comprehensive cardiac screening of HD survivors who fit this profile.
Department of Community and Preventive Medicine, University of Rochester School of Medicine and Dentistry, NY, USA.
M Jacob
MJ
Adams
Stuart R
SR
Lipsitz
Steven D
SD
Colan
Nancy J
NJ
Tarbell
S Ted
ST
Treves
Lisa
L
Diller
Nina
N
Greenbaum
Peter
P
Mauch
Steven E
SE
Lipshultz
D000293:Adolescent; D000328:Adult; D002313:Cardiomyopathy, Restrictive / Q000209:etiology; D002319:Cardiovascular System / Q000503:physiopathology*; D002648:Child; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D006327:Heart Block / Q000209:etiology; D006329:Heart Conduction System / Q000528:radiation effects; D006339:Heart Rate; D006349:Heart Valve Diseases / Q000209:etiology; D006689:Hodgkin Disease / Q000503:physiopathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008482:Mediastinum / Q000528:radiation effects*; D011788:Quality of Life; D011879:Radiotherapy Dosage; D013610:Tachycardia / Q000209:etiology; D013909:Thorax / Q000528:radiation effects; D013997:Time Factors