Cardiovascular status in long-term survivors of Hodgkin's disease treated with chest radiotherapy

M. Jacob Adams, Stuart R. Lipsitz, Steven D. Colan, Nancy J. Tarbell, S. Ted Treves, Lisa Diller, Nina Greenbaum, Peter Mauch, Steven E Lipshultz

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Abstract

Purpose: 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. Patients and 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/m 2) 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). Conclusion: 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.

Original languageEnglish
Pages (from-to)3139-3148
Number of pages10
JournalJournal of Clinical Oncology
Volume22
Issue number15
DOIs
StatePublished - Dec 1 2004

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Hodgkin Disease
Survivors
Radiotherapy
Thorax
Cardiovascular Abnormalities
Exercise
Restrictive Cardiomyopathy
Stress Echocardiography
Heart Block
Anthracyclines
Tachycardia
Dyspnea
Fatigue
Heart Diseases
Electrocardiography
Heart Failure
Heart Rate
Hemodynamics
Quality of Life
Oxygen

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Adams, M. J., Lipsitz, S. R., Colan, S. D., Tarbell, N. J., Treves, S. T., Diller, L., ... Lipshultz, S. E. (2004). Cardiovascular status in long-term survivors of Hodgkin's disease treated with chest radiotherapy. Journal of Clinical Oncology, 22(15), 3139-3148. https://doi.org/10.1200/JCO.2004.09.109

Cardiovascular status in long-term survivors of Hodgkin's disease treated with chest radiotherapy. / Adams, M. Jacob; Lipsitz, Stuart R.; Colan, Steven D.; Tarbell, Nancy J.; Treves, S. Ted; Diller, Lisa; Greenbaum, Nina; Mauch, Peter; Lipshultz, Steven E.

In: Journal of Clinical Oncology, Vol. 22, No. 15, 01.12.2004, p. 3139-3148.

Research output: Contribution to journalArticle

Adams, MJ, Lipsitz, SR, Colan, SD, Tarbell, NJ, Treves, ST, Diller, L, Greenbaum, N, Mauch, P & Lipshultz, SE 2004, 'Cardiovascular status in long-term survivors of Hodgkin's disease treated with chest radiotherapy', Journal of Clinical Oncology, vol. 22, no. 15, pp. 3139-3148. https://doi.org/10.1200/JCO.2004.09.109
Adams, M. Jacob ; Lipsitz, Stuart R. ; Colan, Steven D. ; Tarbell, Nancy J. ; Treves, S. Ted ; Diller, Lisa ; Greenbaum, Nina ; Mauch, Peter ; Lipshultz, Steven E. / Cardiovascular status in long-term survivors of Hodgkin's disease treated with chest radiotherapy. In: Journal of Clinical Oncology. 2004 ; Vol. 22, No. 15. pp. 3139-3148.
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abstract = "Purpose: 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. Patients and 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/m 2) 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). Conclusion: 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.",
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