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Impact of hypertension on left ventricular function in patients after anthracycline chemotherapy for malignant
Yusuke Tanaka1, Hidekazu Tanaka1, Keiko Hatazawa2
1Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
Insights
Hypertension and left ventricular hypertrophy (LVH) increase the risk of cardiac dysfunction during anthracycline chemotherapy for lymphoma. Early monitoring is crucial for patients with these risk factors.
Area of Science:
- Cardiology
- Oncology
- Cardio-oncology
Background:
- Hypertension is a known risk factor for cancer therapeutics-related cardiac dysfunction (CTRCD) and heart failure.
- The specific impact of hypertension and associated left ventricular hypertrophy (LVH) on left ventricular (LV) function during anthracycline chemotherapy for malignant lymphoma is not well understood.
Purpose of the Study:
- To investigate the association between hypertension, LVH, and LV function changes in patients with malignant lymphoma undergoing anthracycline chemotherapy.
- To determine if hypertension and LVH predict the development of CTRCD.
Main Methods:
- Echocardiography was used to assess LV function (LVEF) in 92 malignant lymphoma patients before and two months after anthracycline chemotherapy.
- CTRCD was defined as a ≥10% decrease in LVEF to a final LVEF <53%.
- LVH was defined by relative wall thickness and LV mass index.
Main Results:
- Patients with hypertension showed a significantly greater relative decrease in LVEF post-chemotherapy compared to those without hypertension.
- The prevalence of CTRCD was higher in hypertensive patients, although not statistically significant (17% vs. 5%).
- Hypertension and LVH significantly improved the prediction of CTRCD in logistic regression models.
Conclusions:
- Hypertension, particularly with co-existing LVH, is associated with LV dysfunction after anthracycline chemotherapy in lymphoma patients with preserved LVEF.
- Close monitoring or early intervention is recommended for hypertensive patients with LVH undergoing this treatment.
Background:
Hypertension is considered an important risk factors for cancer therapeutics-related cardiac dysfunction (CTRCD) as well as heart failure. However, the impact of hypertension and left ventricular (LV) hypertrophy (LVH), which is associated with hypertension, on LV function in patients treated with anthracycline chemotherapy for malignant lymphoma remains uncertain.
Method:
We studied 92 patients with malignant lymphoma and with preserved LV ejection fraction (LVEF). Echocardiography was performed before and two-month after anthracycline chemotherapy. CTRCD was defined as the presence of an absolute decrease in LVEF ≥10% to a final value <53%. LVH was defined as concentric hypertrophy, which was determined as relative wall thickness ≥ 0.42 and LV mass index >95 g/m2 for females and > 115 g/m2 for males.
Results:
Relative decrease in LVEF after anthracycline chemotherapy in patients with hypertension (n = 23) was significantly higher than that in patients without hypertension (n = 69) (-5.8% [-9.4, -1.3]) vs. (-1.1% [-4.1, 2.5]); P = .005). Moreover, the prevalence of CTRCD in patients with hypertension tended to be higher than in those without hypertension (17% vs. 5%, p = .09). A sequential logistic model for predicting CTRCD, based on baseline clinical variables including major clinical risk factors, was improved by the addition of the complication of hypertension (P = .049), and further improved by the addition of the presence of LVH (P = .023).
Conclusions:
Hypertension, especially when complicated by LVH, was found to be associated with LV dysfunction after anthracycline chemotherapy in patients with malignant lymphoma and preserved LVEF. Watchful observation or early therapeutic intervention may thus be needed for such patients by the addition of the presence of LVH.
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