Bijl Jesse M, Roos Marleen M, van Leeuwen-Segarceanu Elena M, Vos Josephine M, Bos Willem-Jan W, Biesma Douwe H, Post Marco C
Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands.
Am J Cardiol. 2016 Feb 15;117(4):691-696. doi: 10.1016/j.amjcard.2015.11.027. Epub 2015 Dec 7.
As the number of Hodgkin's lymphoma (HL) survivors grows, understanding long-term complications becomes more important. Mediastinal radiotherapy (MRT) seems to cause valvular disease, and the prevalence might increase during follow-up. In this cross-sectional study 82 HL survivors participated (52% men, mean age 47.8 years, 50 treated with MRT). Valvular disease was diagnosed by transthoracic echocardiography and compared between HL survivors treated with and without MRT. Univariate and multivariate logistic regression analysis was used to identify predictors for valvular disease. During a median follow-up of 13.4 years (range 2 to 39 years), ≥ mild valvular disease was present in 61.2% of HL survivors with MRT (n = 30), compared with 31.0% of HL survivors without MRT (n = 9; odds ratio [OR] 3.51, 95% CI 1.32 to 9.30, p = 0.01). In multivariate analysis, only current age remained predictive for ≥ mild valvular disease (OR 1.08 per year, 95% CI 1.01 to 1.14, p = 0.023). Aortic regurgitation (AR) was most prevalent and irradiated patients had significantly more ≥ mild AR (38.2% vs 6.8%, p = 0.007). Within the MRT subgroup, time after radiation of >15 years was associated with AR (OR 4.70, 95% CI 1.05 to 21.03, p = 0.043), after adjusting for current age and hypertension. Severe valvular disease was present in 24.5% of HL survivors with MRT compared with 3.4% without MRT (p = 0.016). Valvular surgery was performed in 9 HL survivors (18.0%) with MRT and in none without MRT. In conclusion, the prevalence of valvular disease in HL survivors treated with MRT is high and increases with time after irradiation. Long-time screening for valvular disease by transthoracic echocardiography might be worthwhile.
随着霍奇金淋巴瘤（HL）幸存者数量的增加，了解长期并发症变得愈发重要。纵隔放疗（MRT）似乎会引发瓣膜疾病，且在随访期间患病率可能会上升。在这项横断面研究中，82名HL幸存者参与其中（52%为男性，平均年龄47.8岁，50人接受了MRT治疗）。通过经胸超声心动图诊断瓣膜疾病，并对接受和未接受MRT治疗的HL幸存者进行比较。采用单因素和多因素逻辑回归分析来确定瓣膜疾病的预测因素。在中位随访13.4年（范围2至39年）期间，接受MRT治疗的HL幸存者中61.2%（n = 30）存在≥轻度瓣膜疾病，而未接受MRT治疗的HL幸存者中这一比例为31.0%（n = 9；比值比[OR] 3.51，95%置信区间1.32至9.30，p = 0.01）。在多因素分析中，只有当前年龄仍然是≥轻度瓣膜疾病的预测因素（每年OR 1.08，95%置信区间1.01至1.14，p = 0.023）。主动脉瓣反流（AR）最为常见，接受放疗的患者中≥轻度AR明显更多（38.2%对6.8%，p = 0.007）。在MRT亚组中，放疗后>15年与AR相关（OR 4.70，95%置信区间1.05至21.03，p = 0.043），在对当前年龄和高血压进行校正后。接受MRT治疗的HL幸存者中24.5%存在严重瓣膜疾病，而未接受MRT治疗的患者中这一比例为3.4%（p = 0.016）。9名接受MRT治疗的HL幸存者（18.0%）接受了瓣膜手术，未接受MRT治疗的患者无人接受手术。总之，接受MRT治疗的HL幸存者中瓣膜疾病的患病率很高，且随放疗后时间增加。通过经胸超声心动图对瓣膜疾病进行长期筛查可能是值得的。
