Christiansen Jon R, Massey Richard, Dalen Håvard, Kanellopoulos Adriani, Hamre Hanne, Ruud Ellen, Kiserud Cecilie E, Fosså Sophie D, Aakhus Svend
Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway Department of Medicine, Innlandet Hospital Trust, Elverum, Norway
Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
Eur Heart J Cardiovasc Imaging. 2016 Jul;17(7):735-41. doi: 10.1093/ehjci/jew018. Epub 2016 Feb 24.
Little is known about right ventricular (RV) function in survivors of childhood cancer, although both anthracyclines and radiotherapy represent potentially cardiotoxic treatment. We hypothesized that adult survivors of childhood malignant lymphoma or acute lymphoblastic leukaemia would have impaired RV function.
We examined RV dimensions and function by echocardiography in 246 survivors, mean 21.7 years after diagnosis, and in 211 matched controls. Of the survivors, 84% had been exposed to anthracyclines, mediastinal radiotherapy, or both. Compared with controls, all mean measures of RV function were lower in the survivor group: fractional area change (44.5 vs. 48.6%, P < 0.001), tricuspid annular plane systolic excursion (2.24 vs. 2.49 cm, P < 0.001), peak systolic tricuspid annular velocity (12.1 vs. 13.0 cm/s, P < 0.001), and free wall strain (-26.5 vs. -28.4%, P < 0.001). In contrast, there were little differences in RV diastolic dimensions. Lower measures of RV function were found in all survivor subgroups having received cardiotoxic treatment, but not in the 16% of survivors unexposed to anthracyclines or mediastinal radiotherapy. Signs of RV systolic dysfunction were found in 30% of the survivors, and more than 3 times more often in survivors with left ventricular dysfunction.
Long-term survivors of childhood lymphoma or acute lymphoblastic leukaemia frequently have impaired RV function compared with controls. As this is associated with increased risk of heart failure and death in many other conditions, we recommend increased attention to RV function in childhood survivors. Whether RV dysfunction impairs prognosis in this patient group should be examined in longitudinal studies.
尽管蒽环类药物和放射治疗都具有潜在的心脏毒性，但关于儿童癌症幸存者的右心室（RV）功能却知之甚少。我们推测儿童恶性淋巴瘤或急性淋巴细胞白血病的成年幸存者右心室功能会受损。
我们通过超声心动图检查了246名幸存者（诊断后平均21.7年）和211名匹配对照者的右心室大小和功能。在这些幸存者中，84%曾接触过蒽环类药物、纵隔放疗或两者皆有。与对照组相比，幸存者组右心室功能的所有平均指标均较低：面积变化分数（44.5%对48.6%，P<0.001）、三尖瓣环平面收缩期位移（2.24 cm对2.49 cm，P<0.001）、三尖瓣环收缩期峰值速度（12.1 cm/s对13.0 cm/s，P<0.001）和游离壁应变（-26.5%对-28.4%，P<0.001）。相比之下，右心室舒张期大小差异不大。在所有接受过心脏毒性治疗的幸存者亚组中均发现右心室功能指标较低，但在未接触过蒽环类药物或纵隔放疗的16%幸存者中未发现。30%的幸存者存在右心室收缩功能障碍的迹象，在左心室功能障碍的幸存者中出现的频率是其3倍多。
与对照组相比，儿童淋巴瘤或急性淋巴细胞白血病的长期幸存者右心室功能经常受损。由于在许多其他情况下这与心力衰竭和死亡风险增加相关，我们建议更加关注儿童幸存者的右心室功能。右心室功能障碍是否会影响该患者群体的预后应在纵向研究中进行考察。
