Left ventricular function assessed by two-dimensional speckle tracking echocardiography in long-term survivors of Hodgkin's lymphoma treated by mediastinal radiotherapy with or without anthracycline therapy.
Anthracycline therapy is well known for its adverse cardiac effects. However, few studies have been performed of the long-term follow-up of myocardial function in adult survivors of Hodgkin's lymphoma receiving anthracycline. Two-dimensional speckle tracking echocardiography is an accurate angle-independent modality for the quantification of left ventricular (LV) function. The aim of the present study was to investigate the long-term effect of anthracycline on LV systolic function. Echocardiography was performed in 47 survivors of Hodgkin's lymphoma 22 ± 2 years after successful mediastinal radiotherapy with (n = 27) or without (n = 20) anthracycline (doxorubicin) treatment and in 20 healthy controls. LV function was assessed by the LV ejection fraction and global longitudinal and circumferential strain. Both patient groups had received a similar dosage of radiation, and doxorubicin was given at a total dose of 309 ± 92 mg. The global longitudinal strain was reduced in patients receiving anthracycline with mediastinal radiotherapy compared to the other group receiving mediastinal radiotherapy alone or combined radiotherapy and regimens without anthracyclines (-16.1 ± 1.9% vs -17.5 ± 1.7%, respectively, p <0.05). Both patient groups had reduced strain compared to the healthy controls (-20.4 ± 1.7%, both p <0.001). The circumferential strain was also reduced in the treatment groups (-18.3 ± 3.2% and -17.8 ± 3.6% vs -22.5 ± 2.1%, both p <0.001). The LV ejection fraction did not differ between the patient groups (55 ± 8% vs 56 ± 6%, p = 1.0) but was reduced compared to that of the controls (62 ± 5%, both p <0.05). In conclusion, myocardial function was reduced in the survivors of Hodgkin's lymphoma 2 decades after successful treatment consisting of mediastinal radiotherapy with or without chemotherapy. Patients receiving anthracycline therapy had additional negative long-tem effects on LV systolic function.
Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway.
Huey-Ru
HR
Tsai
Ola
O
Gjesdal
Torgeir
T
Wethal
Kristina Hermann
KH
Haugaa
Alexander
A
Fosså
Sophie Dorothea
SD
Fosså
Thor
T
Edvardsen
D000903:Antibiotics, Antineoplastic / Q000009:adverse effects*; D003131:Combined Modality Therapy; D004317:Doxorubicin / Q000009:adverse effects*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006689:Hodgkin Disease / Q000503:physiopathology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008482:Mediastinum / Q000528:radiation effects; D008875:Middle Aged; D013318:Stroke Volume / Q000187:drug effects; D013997:Time Factors; D016277:Ventricular Function, Left / Q000187:drug effects* / Q000502:physiology
D000903:Antibiotics, Antineoplastic; D004317:Doxorubicin