Polomski Elissa A S, Heemelaar Julius C, Krol Augustinus D G, Louwerens Marloes, Beeres Saskia L M A, Holman Eduard R, Jukema J Wouter, Schalij Martin J, Antoni M Louisa
Department of Cardiology, Heart Lung Center, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
Department of Radiotherapy, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
Cancers (Basel). 2022 May 8;14(9):2329. doi: 10.3390/cancers14092329.
Background: Treatment with thoracic irradiation for classic Hodgkin lymphoma (CHL) leads to improved survival but also increases the risk of cardiovascular events. Left ventricular (LV) dysfunction is usually assessed by echocardiographic left ventricular ejection fraction (LVEF), whereas global longitudinal strain (GLS) can detect early subclinical LV dysfunction. The purpose of this study was to evaluate if conventional echocardiographic parameters and GLS are associated with cardiovascular events during long-term follow-up. Methods: 161 consecutive CHL patients treated with radiotherapy who underwent echocardiography > 10 years after diagnosis were assessed for eligibility. Multivariable cause-specific Cox regression was performed for a composite outcome of cardiac death and cardiovascular events and the competing outcome of noncardiac death. Results: 129 patients (61.2% female, N = 79) with a mean age of 46.3 ± 11.0 years at index visit were eligible for analysis. GLS was impaired in 51 patients (39.5%) and 10.9% had a LVEF of< 50%. The median E/e’ was 9.2 [7.2;12.7]. Adjusted for confounders, GLS > −16% showed a significant association with a near four-fold risk of the composite endpoint (HR = 3.95, 95% CI: 1.83−8.52, p < 0.001). LVEF < 50% (HR = 2.99, p = 0.016) and E/e’ (HR = 1.16, p < 0.001) also showed a significant relationship with the outcome. None of the aforementioned parameters were associated with the competing outcome. Conclusions: This study shows that LV dysfunction including impaired GLS in CHL survivors is associated with cardiovascular events and cardiac death.
经典型霍奇金淋巴瘤（CHL）患者接受胸部放疗可提高生存率，但也会增加心血管事件风险。左心室（LV）功能障碍通常通过超声心动图测量左心室射血分数（LVEF）来评估，而整体纵向应变（GLS）能够检测早期亚临床LV功能障碍。本研究旨在评估常规超声心动图参数和GLS是否与长期随访期间的心血管事件相关。方法：对161例接受放疗的连续CHL患者进行评估，这些患者在诊断后10年以上接受了超声心动图检查以确定是否符合条件。对心脏死亡和心血管事件的复合结局以及非心脏死亡的竞争结局进行多变量特定病因Cox回归分析。结果：129例患者（61.2%为女性，N = 79）符合分析条件，首次就诊时的平均年龄为46.3±11.0岁。51例患者（39.5%）的GLS受损，10.9%的患者LVEF<50%。E/e’的中位数为9.2[7.2；12.7]。在对混杂因素进行校正后，GLS>-16%与复合终点事件风险近四倍增加显著相关（HR = 3.95，95%CI：1.83−8.52，p<0.001）。LVEF<50%（HR = 2.99，p = 0.016）和E/e’（HR = 1.16，p<0.001）也与结局显著相关。上述参数均与竞争结局无关。结论：本研究表明，CHL幸存者中包括GLS受损在内的LV功能障碍与心血管事件和心脏死亡相关。
