Piovaccari G, Ferretti R M, Prati F, Traini A M, Gobbi M, Caravita L, Branzi A, Magnani B
Istituto di Malattie dell'Apparato Cardiovascolare, Università degli Studi di Bologna, Italy.
Int J Cardiol. 1995 Mar 24;49(1):39-43. doi: 10.1016/0167-5273(95)02276-3.
Occult or overt but delayed cardiac disease after thoracic radiotherapy for Hodgkin's disease may be common. Detailed cardiac evaluation was performed in 108 patients, mean age 46 +/- 6.2 years, with Hodgkin's disease at 175 +/- 43 months after irradiation. The study protocol included clinical examination, graded treadmill exercise test and echocardiography. Some patients with angina pectoris, previous myocardial infarction and an abnormal ECG were studied by thallium-201 scintigraphy, cardiac catheterization and coronary angiography. Cardiac disease was found in 12 patients (11%). Three patients had angina pectoris, one patient had myocardial infarction, two complained of dyspnea on effort and two had congestive heart failure. At catheterization, constrictive pericarditis was diagnosed in four patients; in two additional patients an occult constrictive pericarditis was found. One patient had both mitral and tricuspidal regurgitation and one had mitral regurgitation alone. Eight patients (7.4%) had severe coronary artery disease; four of these had associated constrictive pericarditis. Four patients had a pericardiectomy and another four had undergone coronary artery by-pass graft. Two patients died after operation from persistent pericardial constriction. It is concluded that the incidence of delayed cardiac disease after radiotherapy is relatively high; chronic pericardial disorders and coronary artery disease are the most frequent manifestations of this disease. Standard surgical treatment may be beneficial because of the relative youth of these patients.
霍奇金病胸部放疗后隐匿性或显性但延迟出现的心脏疾病可能很常见。对108例平均年龄46±6.2岁的霍奇金病患者在放疗后175±43个月进行了详细的心脏评估。研究方案包括临床检查、分级运动平板试验和超声心动图检查。对一些有胸痛、既往心肌梗死和心电图异常的患者进行了铊-201闪烁显像、心导管检查和冠状动脉造影。12例患者（11%）发现有心脏疾病。3例有胸痛，1例有心肌梗死，2例诉说运动时呼吸困难，2例有充血性心力衰竭。心导管检查时，4例患者被诊断为缩窄性心包炎；另外2例发现有隐匿性缩窄性心包炎。1例患者同时有二尖瓣和三尖瓣反流，1例仅有二尖瓣反流。8例患者（7.4%）有严重冠状动脉疾病；其中4例合并缩窄性心包炎。4例患者进行了心包切除术，另外4例接受了冠状动脉搭桥术。2例患者术后死于持续性心包缩窄。结论是放疗后延迟性心脏疾病的发生率相对较高；慢性心包疾病和冠状动脉疾病是这种疾病最常见的表现。由于这些患者相对年轻，标准的手术治疗可能有益。
