title: Heart Failure and Asymptomatic Left Ventricular Systolic Dysfunction in Lymphoma Survivors Treated With Autologous Stem-Cell Transplantation: A National Cross-Sectional Study.
abstract: OBJECTIVE
  We aimed to determine the prevalence of left ventricular systolic dysfunction (LVSD), including symptomatic (ie, heart failure [HF]) and asymptomatic LVSD in adult lymphoma survivors (LSs) after autologous hematopoietic stem-cell transplantation (auto-HCT) and to identify risk factors for LVSD in this population.
  
  
  METHODS
  All LSs treated with auto-HCT as adults in Norway from 1987 to 2008 were eligible for this national cross-sectional study. Asymptomatic LVSD was defined as left ventricular ejection fraction less than 50% by echocardiography, and HF was defined according to current recommendations. The results in LSs were compared with those found in an age- and sex-matched (1:1) control group.
  
  
  RESULTS
  We examined 274 LSs (69% of all eligible survivors); 62% were men, the mean (± standard deviation) age was 56 ± 12 years, and mean follow-up time from lymphoma diagnosis was 13 ± 6 years. The mean cumulative doxorubicin dose was 316 ± 111 mg/m(2), and 35% of LSs had received additional radiation therapy involving the heart. We found LVSD in 15.7% of the LSs, of whom 5.1% were asymptomatic. HF patients were symptomatically mildly affected, with 8.8% of all LSs classified as New York Heart Association class II, whereas more severe HF was rare (1.8%). Compared with controls, LSs had a substantially increased LVSD risk (odds ratio, 6.6; 95% CI, 2.5 to 17.6; P < .001). A doxorubicin dose ≥ 300 mg/m(2) and cardiac radiation therapy dose greater than 30 Gy were independent risk factors for LVSD.
  
  
  CONCLUSIONS
  LVSD was frequent and HF more prevalent than previously reported in LSs after auto-HCT. Our results may help to identify LSs at increased LVSD risk and can serve as a basis for targeted surveillance strategies.
authors.affiliation: Klaus Murbraech, Knut B. Smeland, Harald Holte, Jon Håvard Loge, May Brit Lund, Stein Kvaløy, Ragnhild S. Falk, Svend Aakhus, and Cecilie E. Kiserud, Oslo University Hospital; Jon Håvard Loge and Stein Kvaløy, University of Oslo, Oslo; Torgeir Wethal and Espen Holte, St Olavs Hospital, University of Trondheim; Håvard Dalen, Norwegian University of Science and Technology; Svend Aakhus, University of Trondheim, Trondheim; Assami Rösner, University Hospital North Norway, Tromsø; and Håvard Dalen, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway. sbmurk@ous-hf.no.
authors.forename: Klaus
authors.initials: K
authors.lastname: Murbraech
authors.affiliation: Klaus Murbraech, Knut B. Smeland, Harald Holte, Jon Håvard Loge, May Brit Lund, Stein Kvaløy, Ragnhild S. Falk, Svend Aakhus, and Cecilie E. Kiserud, Oslo University Hospital; Jon Håvard Loge and Stein Kvaløy, University of Oslo, Oslo; Torgeir Wethal and Espen Holte, St Olavs Hospital, University of Trondheim; Håvard Dalen, Norwegian University of Science and Technology; Svend Aakhus, University of Trondheim, Trondheim; Assami Rösner, University Hospital North Norway, Tromsø; and Håvard Dalen, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway.
authors.forename: Knut B
authors.initials: KB
authors.lastname: Smeland
authors.affiliation: Klaus Murbraech, Knut B. Smeland, Harald Holte, Jon Håvard Loge, May Brit Lund, Stein Kvaløy, Ragnhild S. Falk, Svend Aakhus, and Cecilie E. Kiserud, Oslo University Hospital; Jon Håvard Loge and Stein Kvaløy, University of Oslo, Oslo; Torgeir Wethal and Espen Holte, St Olavs Hospital, University of Trondheim; Håvard Dalen, Norwegian University of Science and Technology; Svend Aakhus, University of Trondheim, Trondheim; Assami Rösner, University Hospital North Norway, Tromsø; and Håvard Dalen, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway.
authors.forename: Harald
authors.initials: H
authors.lastname: Holte
authors.affiliation: Klaus Murbraech, Knut B. Smeland, Harald Holte, Jon Håvard Loge, May Brit Lund, Stein Kvaløy, Ragnhild S. Falk, Svend Aakhus, and Cecilie E. Kiserud, Oslo University Hospital; Jon Håvard Loge and Stein Kvaløy, University of Oslo, Oslo; Torgeir Wethal and Espen Holte, St Olavs Hospital, University of Trondheim; Håvard Dalen, Norwegian University of Science and Technology; Svend Aakhus, University of Trondheim, Trondheim; Assami Rösner, University Hospital North Norway, Tromsø; and Håvard Dalen, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway.
authors.forename: Jon Håvard
authors.initials: JH
authors.lastname: Loge
authors.affiliation: Klaus Murbraech, Knut B. Smeland, Harald Holte, Jon Håvard Loge, May Brit Lund, Stein Kvaløy, Ragnhild S. Falk, Svend Aakhus, and Cecilie E. Kiserud, Oslo University Hospital; Jon Håvard Loge and Stein Kvaløy, University of Oslo, Oslo; Torgeir Wethal and Espen Holte, St Olavs Hospital, University of Trondheim; Håvard Dalen, Norwegian University of Science and Technology; Svend Aakhus, University of Trondheim, Trondheim; Assami Rösner, University Hospital North Norway, Tromsø; and Håvard Dalen, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway.
authors.forename: May Brit
authors.initials: MB
authors.lastname: Lund
authors.affiliation: Klaus Murbraech, Knut B. Smeland, Harald Holte, Jon Håvard Loge, May Brit Lund, Stein Kvaløy, Ragnhild S. Falk, Svend Aakhus, and Cecilie E. Kiserud, Oslo University Hospital; Jon Håvard Loge and Stein Kvaløy, University of Oslo, Oslo; Torgeir Wethal and Espen Holte, St Olavs Hospital, University of Trondheim; Håvard Dalen, Norwegian University of Science and Technology; Svend Aakhus, University of Trondheim, Trondheim; Assami Rösner, University Hospital North Norway, Tromsø; and Håvard Dalen, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway.
authors.forename: Torgeir
authors.initials: T
authors.lastname: Wethal
authors.affiliation: Klaus Murbraech, Knut B. Smeland, Harald Holte, Jon Håvard Loge, May Brit Lund, Stein Kvaløy, Ragnhild S. Falk, Svend Aakhus, and Cecilie E. Kiserud, Oslo University Hospital; Jon Håvard Loge and Stein Kvaløy, University of Oslo, Oslo; Torgeir Wethal and Espen Holte, St Olavs Hospital, University of Trondheim; Håvard Dalen, Norwegian University of Science and Technology; Svend Aakhus, University of Trondheim, Trondheim; Assami Rösner, University Hospital North Norway, Tromsø; and Håvard Dalen, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway.
authors.forename: Espen
authors.initials: E
authors.lastname: Holte
authors.affiliation: Klaus Murbraech, Knut B. Smeland, Harald Holte, Jon Håvard Loge, May Brit Lund, Stein Kvaløy, Ragnhild S. Falk, Svend Aakhus, and Cecilie E. Kiserud, Oslo University Hospital; Jon Håvard Loge and Stein Kvaløy, University of Oslo, Oslo; Torgeir Wethal and Espen Holte, St Olavs Hospital, University of Trondheim; Håvard Dalen, Norwegian University of Science and Technology; Svend Aakhus, University of Trondheim, Trondheim; Assami Rösner, University Hospital North Norway, Tromsø; and Håvard Dalen, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway.
authors.forename: Assami
authors.initials: A
authors.lastname: Rösner
authors.affiliation: Klaus Murbraech, Knut B. Smeland, Harald Holte, Jon Håvard Loge, May Brit Lund, Stein Kvaløy, Ragnhild S. Falk, Svend Aakhus, and Cecilie E. Kiserud, Oslo University Hospital; Jon Håvard Loge and Stein Kvaløy, University of Oslo, Oslo; Torgeir Wethal and Espen Holte, St Olavs Hospital, University of Trondheim; Håvard Dalen, Norwegian University of Science and Technology; Svend Aakhus, University of Trondheim, Trondheim; Assami Rösner, University Hospital North Norway, Tromsø; and Håvard Dalen, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway.
authors.forename: Håvard
authors.initials: H
authors.lastname: Dalen
authors.affiliation: Klaus Murbraech, Knut B. Smeland, Harald Holte, Jon Håvard Loge, May Brit Lund, Stein Kvaløy, Ragnhild S. Falk, Svend Aakhus, and Cecilie E. Kiserud, Oslo University Hospital; Jon Håvard Loge and Stein Kvaløy, University of Oslo, Oslo; Torgeir Wethal and Espen Holte, St Olavs Hospital, University of Trondheim; Håvard Dalen, Norwegian University of Science and Technology; Svend Aakhus, University of Trondheim, Trondheim; Assami Rösner, University Hospital North Norway, Tromsø; and Håvard Dalen, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway.
authors.forename: Stein
authors.initials: S
authors.lastname: Kvaløy
authors.affiliation: Klaus Murbraech, Knut B. Smeland, Harald Holte, Jon Håvard Loge, May Brit Lund, Stein Kvaløy, Ragnhild S. Falk, Svend Aakhus, and Cecilie E. Kiserud, Oslo University Hospital; Jon Håvard Loge and Stein Kvaløy, University of Oslo, Oslo; Torgeir Wethal and Espen Holte, St Olavs Hospital, University of Trondheim; Håvard Dalen, Norwegian University of Science and Technology; Svend Aakhus, University of Trondheim, Trondheim; Assami Rösner, University Hospital North Norway, Tromsø; and Håvard Dalen, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway.
authors.forename: Ragnhild S
authors.initials: RS
authors.lastname: Falk
authors.affiliation: Klaus Murbraech, Knut B. Smeland, Harald Holte, Jon Håvard Loge, May Brit Lund, Stein Kvaløy, Ragnhild S. Falk, Svend Aakhus, and Cecilie E. Kiserud, Oslo University Hospital; Jon Håvard Loge and Stein Kvaløy, University of Oslo, Oslo; Torgeir Wethal and Espen Holte, St Olavs Hospital, University of Trondheim; Håvard Dalen, Norwegian University of Science and Technology; Svend Aakhus, University of Trondheim, Trondheim; Assami Rösner, University Hospital North Norway, Tromsø; and Håvard Dalen, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway.
authors.forename: Svend
authors.initials: S
authors.lastname: Aakhus
authors.affiliation: Klaus Murbraech, Knut B. Smeland, Harald Holte, Jon Håvard Loge, May Brit Lund, Stein Kvaløy, Ragnhild S. Falk, Svend Aakhus, and Cecilie E. Kiserud, Oslo University Hospital; Jon Håvard Loge and Stein Kvaløy, University of Oslo, Oslo; Torgeir Wethal and Espen Holte, St Olavs Hospital, University of Trondheim; Håvard Dalen, Norwegian University of Science and Technology; Svend Aakhus, University of Trondheim, Trondheim; Assami Rösner, University Hospital North Norway, Tromsø; and Håvard Dalen, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway.
authors.forename: Cecilie E
authors.initials: CE
authors.lastname: Kiserud
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D008223:Lymphoma / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D033581:Stem Cell Transplantation / Q000379:methods*; D014182:Transplantation, Autologous; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*