Impaired LV systolic function in lymphoma survivors after mediastinal radiotherapy

Abstract

Purpose: Lymphoma survivors (LS) have increased risk for cardiovascular diseases because of cardiotoxic treatment, such as anthracyclines (AC) and mediastinal radiotherapy (MRT). We wanted to assess LV systolic function after the influence of MRT in LS after high dose chemotherapy with autologous stem cell transplantation (HDT). Methods: We studied 100 LS (70% men) included in a Norwegian national cross-sectional follow-up study of all LS after HDT. Twenty LS were also given MRT (median 30 Gy, range 20-40), as part of their primary treatment. All LS had received AC (MRT-group 312 mg/m2±83 vs 321±117 mg/m2, p=0.69). The MRT-group was younger (mean 47±10 yr) than the non-radiated group (n=80, mean 59±11, p<0.0001), but time since primary diagnosis did not differ significantly (MRT-group 11±6 yr vs 10±4 yr, p=0.23). Echocardiograms were obtained by a Vivid 7 or E9 (GE Vingmed, Norway) after convention. LVEF was measured by traditional biplane Simpson method and global longitudinal strain (GLS) by two-dimensional speckle tracking. Results: Whereas LVEF did not differ significantly (MRT-group; 53±8% vs 56±5%, p=0.13), GLS was decreased in the MRT-group (-17.5±2.5% vs -19.1±2.4%, p=0.03). Displacement at the lateral mitral annulus measured by tissue-Doppler was significantly lower in the MRT-group (11.0±2.0 mm vs 12.9±2.8 mm, p=0.002). See table 1 for other results. Nine patients had LVEF <50% (median 42%, range 27-49), and only one patient was classified in New York Heart Association (NYHA) Class III, whilst the others were in NYHA I-II. View this table: Table 1 Conclusions: Although, symptomatic heart failure was very rare, GLS was able to detect a subclinical decline in LV systolic function after MRT + AC vs AC alone in LS after HDT.