title: Increased tricuspid regurgitant jet velocity by Doppler echocardiography in adult survivors of childhood cancer: a report from the St Jude Lifetime Cohort Study.
abstract: OBJECTIVE
  To determine the prevalence of pulmonary hypertension, a late effect of cancer therapy not previously identified in aging survivors of childhood cancer, and associations with chest-directed radiation therapy (RT) and measures of current cardiac function, lung function, and exercise capacity.
  
  
  METHODS
  Cross-sectional evaluation of 498 survivors at a median age of 38.0 years (range, 20.0 to 59.0 years) and a median of 27.3 years (range, 12.2 to 46.0 years) from primary cancer diagnosis was performed. Abnormal tricuspid regurgitant jet velocity (TRV) was defined as more than 2.8 m/s by Doppler echocardiography.
  
  
  RESULTS
  Increased TRV was identified in 25.2% of survivors who received chest-directed RT and 30.8% of those who received more than 30 Gy. In multivariable models, increased TRV was associated with increasing dose of RT (1 to 19.9 Gy: odds ratio [OR], 2.09; 95% CI, 0.63 to 6.96; 20 to 29.9 Gy: OR, 3.46; 95% CI, 1.59 to 7.54; ≥ 30 Gy: OR, 4.54; 95% CI, 1.77 to 11.64 compared with no RT; P for trend < .001), body mass index more than 40 kg/m(2) (OR, 3.89; 95% CI, 1.46 to 10.39), and aortic valve regurgitation (OR, 5.85; 95% CI, 2.05 to 16.74). Survivors with a TRV more than 2.8 m/s had increased odds (OR, 5.20; 95% CI, 2.5 to 11.0) of severe functional limitation on a 6-minute walk compared with survivors with a TRV ≤ 2.8 m/s.
  
  
  CONCLUSIONS
  A substantial number of adult survivors of childhood cancer who received chest-directed RT have an increased TRV and may have pulmonary hypertension as a result of both direct lung injury and cardiac dysfunction. Longitudinal follow-up and confirmation by cardiac catheterization are warranted.
authors.affiliation: Department of Epidemiology & Cancer Control, St Jude Children's Research Hospital, Memphis, TN 38105, USA. greg.armstrong@stjude.org
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Armstrong
authors.forename: Vijaya M
authors.initials: VM
authors.lastname: Joshi
authors.forename: Liang
authors.initials: L
authors.lastname: Zhu
authors.forename: Deokumar
authors.initials: D
authors.lastname: Srivastava
authors.forename: Nan
authors.initials: N
authors.lastname: Zhang
authors.forename: Kirsten K
authors.initials: KK
authors.lastname: Ness
authors.forename: Dennis C
authors.initials: DC
authors.lastname: Stokes
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Krasin
authors.forename: James A
authors.initials: JA
authors.lastname: Fowler
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Green
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler / Q000379:methods*; D015444:Exercise / Q000502:physiology; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology; D007223:Infant; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009369:Neoplasms / Q000150:complications / Q000503:physiopathology* / Q000532:radiotherapy; D012129:Respiratory Function Tests; D012307:Risk Factors; D017741:Survivors; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D016138:Walking / Q000502:physiology; D055815:Young Adult