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Radiation effects on left ventricular function and myocardial perfusion in long term survivors of Hodgkin's disease
D E Savage1, L S Constine, R G Schwartz
1Department of Radiation Oncology, University of Rochester, NY 14642.
Insights
Radiation therapy for Hodgkin's disease can impact heart function, with larger radiation volumes linked to reduced left ventricular ejection fraction (LVEF) and peak filling rate (PFR). These changes, while statistically significant, are not clinically significant at this time.
Area of Science:
- Cardiology
- Oncology
- Radiology
Background:
- Radiation therapy for Hodgkin's disease (HD) can affect cardiac function.
- Assessing long-term cardiovascular effects in HD survivors is crucial.
Purpose of the Study:
- To evaluate left ventricular (LV) systolic and diastolic function in patients previously treated with radiation therapy (RT) for HD.
- To determine if the volume of heart irradiated correlates with cardiac performance indices.
Main Methods:
- Radionuclide angiocardiography and thallium scintigraphy were used to assess LV performance and myocardial perfusion.
- 16 patients previously irradiated for HD were evaluated 2.5-21.5 years post-RT.
- Patients were categorized into two groups based on whether the entire heart volume or a portion was irradiated.
Main Results:
- No significant perfusion defects were observed.
- Patients irradiated to the entire cardiac volume (Group I) showed lower mean LV ejection fraction (LVEF) (55% vs 63%, p=0.01) and peak filling rate (PFR) (3.0 vs 3.8 EDV/sec, p=0.04) compared to those with shielded portions (Group II).
- All measured indices remained within normal ranges.
Conclusions:
- Irradiation of larger cardiac volumes in HD survivors is associated with statistically significant, albeit not clinically apparent, reductions in LV systolic and diastolic function.
- Long-term cardiac monitoring is important for HD survivors treated with RT.
Abstract:
We evaluated systolic and diastolic indices of left ventricular performance by radionuclide angiocardiography and myocardial perfusion with exercise/rest thallium scintigraphy in 16 patients previously irradiated for Hodgkin's disease. These commonly used indices of left ventricular (LV) performance included LV ejection fraction (LVEF) as a measure of systolic function, and LV peak filling rate (PFR) as a measure of diastolic function. The presence of coronary artery disease (CAD) was evaluated by ECG treadmill testing (13 patients) and by quantitative planar thallium scintigraphy (12 patients). Patients were 16-38 years old (mean 24.9 +/- SD 6.2) at the tim eof irradiation, and were evaluated 2.5-21.5 years (mean 9.3 +/- 6.3) after radiation therapy (RT). RT was delivered with beam energies of 2-18 MV, equally weighted AP-PA mantle fields with both fields treated daily for most patients (13 patients), and fraction sizes of 1.5-2.0 Gy. Six patients received radiation to th entire cardiac volume, most commonly via left-sided partial transmission lung blocks (PTLB). Patient data were analyzed according to the volume of heart treated. Individuals who had the entire cardiac volume irradiated were assigned to group I (N = 6), and those patients who had some portion of the heart shielded throughout treatment comprised group II (N = 10). In this series, no perfusion defects were evident in either group by quantitative planar thallium scintigraphy. Mean LVEF for all patients studied was 60% (normal LVEF greater than or equal to 50%). Patients in group I had a lower mean LVEF than those in group II, 55 +/- 4% versus 63 +/- 6% (p = 0.01). Mean PFR for all patients studied was normal at 3.5 EDV/sec (normal PFR greater than or equal to 2.54 EDV/sec). Patients in group I had a lower mean PFR than those in group II, 3.0 +/- 0.6 vs 3.8 +/- 0.7 EDV/sec (p = 0.04). Thus, patients irradiated to large cardiac and pulmonary volumes had lower LVEF and PFR within the normal range compared to patients who had some portion of the cardiac volume shielded. These differences are statistically significant in the relatively small groups studied but do not appear to be associated at the present time with clinically significant effects.