Valvular dysfunction and left ventricular changes in Hodgkin's lymphoma survivors. A longitudinal study.
OBJECTIVE
Hodgkin's lymphoma survivors (HLSs) have an elevated risk for cardiovascular diseases that appear several years after radiotherapy. This study examined the time-dependent development and evolution of valvular and myocardial function related to treatment with mediastinal radiotherapy and anthracyclines in HLSs.


METHODS
In 1993, echocardiography was performed in 116 HLSs median 10 years (range 6-13 years) after treatment with mediastinal radiotherapy. None of the 116 patients had valvular stenosis in 1993 whereas 36 (31%) had moderate valvular regurgitation. In 2005-2007, 51 of 57 invited patients were included in a second echocardiographic study - median 22 years (range 11-27 years) after treatment. Of these patients, 28 (55%) had also received anthracyclines. The patients were selected on the basis of the presence or absence of moderate valvular regurgitation in 1993.


RESULTS
The second echocardiographic study demonstrated that 10 out of 27 (37%) patients with only mild or no aortic or mitral regurgitation in 1993 had developed moderate regurgitation in either or both the aortic or mitral valve. Of the 24 patients with moderate (n=23) or severe (n=1) regurgitation in the aortic or mitral valve in 1993, 8 (33%) had progressed to severe regurgitation, developed moderate regurgitation in a previously normal or mild regurgitant valve or had received valvular replacement. In total, of all patients, 20 (39%) had developed mild to severe aortic stenosis and 3 patients had received valvular replacement. In a multiple linear regression the use of anthracyclines predicted left ventricular remodelling between ECHO 1993 and 2005 as demonstrated by increased left ventricular end systolic diameter (beta =0.09 (95% CI 0.01-0.17), P=0.04) and reduced thickness of the left ventricular posterior wall (beta =-0.18 (95% CI -0.33 to -0.03), P=0.02) and interventricular septum (beta =-0.16 (95% CI -0.30 to -0.03), P=0.02).


CONCLUSIONS
Given the progressive nature of valvular dysfunction and left ventricular remodelling 20-30 years after diagnosis, we recommend life-long cardiological follow-up of HLSs treated with mediastinal radiotherapy.
Wethal
T
T
Department of Cardiology, University of Oslo, Sognsvannsveien 20, Oslo 0027, Norway.
Lund
M-B
MB
Edvardsen
T
T
Fosså
S D
SD
Pripp
A H
AH
Holte
H
H
Kjekshus
J
J
Fosså
A
A
D000293:Adolescent; D000328:Adult; D018943:Anthracyclines / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001021:Aortic Valve / Q000187:drug effects / Q000528:radiation effects; D004452:Echocardiography; D006349:Heart Valve Diseases / Q000209:etiology*; D006352:Heart Ventricles / Q000187:drug effects / Q000473:pathology* / Q000528:radiation effects; D006689:Hodgkin Disease / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008479:Mediastinal Neoplasms / Q000628:therapy*; D008875:Middle Aged; D008943:Mitral Valve / Q000187:drug effects / Q000528:radiation effects; D009367:Neoplasm Staging; D011878:Radiotherapy / Q000009:adverse effects*; D017741:Survivors; D020257:Ventricular Remodeling / Q000187:drug effects / Q000528:radiation effects; D055815:Young Adult
D018943:Anthracyclines; D000970:Antineoplastic Agents