长期淋巴瘤幸存者的右心室功能受损

Impaired Right Ventricular Function in Long-Term Lymphoma Survivors.

作者信息

Murbraech Klaus, Holte Espen, Broch Kaspar, Smeland Knut B, Holte Harald, Rösner Assami, Lund May Brit, Dalen Håvard, Kiserud Cecilie, Aakhus Svend

机构信息

Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.

Department of Cardiology, St Olavs Hospital, University of Trondheim, Trondheim, Norway.

出版信息

J Am Soc Echocardiogr. 2016 Jun;29(6):528-36. doi: 10.1016/j.echo.2016.02.014. Epub 2016 Mar 30.

DOI:10.1016/j.echo.2016.02.014

PMID:27038515

Abstract

BACKGROUND

Cardiotoxicity from anthracyclines or cardiac radiation therapy is detrimental to left ventricular (LV) function. However, the long-term effects on right ventricular (RV) performance are largely unknown. The aim of this study was to investigate the long-term impact of cardiotoxic treatment on RV function among adult cancer survivors.

METHODS

Adult lymphoma survivors (LSs) who underwent autologous hematopoietic stem cell transplantation in Norway from 1987 to 2008 were invited to undergo cardiovascular evaluation by echocardiography and cardiopulmonary exercise testing. In total, 274 LSs participated. The mean age was 56 ± 12 years, and the mean follow-up time since lymphoma diagnosis was 13 ± 6 years. Echocardiographic parameters were compared with those of age- and gender-matched control subjects from an existing large Norwegian database. RV systolic dysfunction was indicated by two or more abnormal RV systolic parameters according to current recommendations. LV systolic dysfunction was indicated by LV global longitudinal strain > -17%.

RESULTS

All parameters of RV systolic function were impaired in LSs compared with control subjects (P < .01 for all). The most pronounced difference was observed for tricuspid annular plane systolic excursion: 22.9 ± 4.1 versus 27.1 ± 4.2 mm. Greater cardiotoxic treatment burden was associated with larger RV functional impairment. Tricuspid annular plane systolic excursion correlated with peak oxygen consumption (r = 0.23, P = .001). RV systolic performance was associated with LV systolic function (r = 0.49, P < .001 for tricuspid annular plane systolic excursion vs LV global longitudinal strain), but a greater proportion of patients had LV dysfunction (30.8%) compared with RV dysfunction (6.2%) (P < .001).

CONCLUSIONS

RV systolic function was impaired in LSs. The association between RV and LV function indicates a global, long-term cardiotoxic effect. However, RV dysfunction was less prevalent than LV dysfunction.

摘要

背景

蒽环类药物或心脏放射治疗引起的心脏毒性对左心室（LV）功能有害。然而，其对右心室（RV）功能的长期影响在很大程度上尚不清楚。本研究的目的是调查心脏毒性治疗对成年癌症幸存者右心室功能的长期影响。

方法

邀请1987年至2008年在挪威接受自体造血干细胞移植的成年淋巴瘤幸存者（LSs）接受超声心动图和心肺运动试验的心血管评估。共有274名LSs参与。平均年龄为56±12岁，自淋巴瘤诊断后的平均随访时间为13±6年。将超声心动图参数与来自挪威一个现有大型数据库的年龄和性别匹配的对照受试者的参数进行比较。根据当前建议，两个或更多异常的右心室收缩参数表明右心室收缩功能障碍。左心室收缩功能障碍由左心室整体纵向应变>-17%表示。

结果

与对照受试者相比，LSs右心室收缩功能的所有参数均受损（所有P<0.01）。三尖瓣环平面收缩期位移观察到最明显的差异：22.9±4.1对27.1±4.2mm。更大的心脏毒性治疗负担与更大的右心室功能损害相关。三尖瓣环平面收缩期位移与峰值耗氧量相关（r=0.23，P=0.001）。右心室收缩功能与左心室收缩功能相关（三尖瓣环平面收缩期位移与左心室整体纵向应变的r=0.49，P<0.001），但与右心室功能障碍（6.2%）相比，有更大比例的患者存在左心室功能障碍（30.8%）（P<0.001）。