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Echocardiographic Findings in Asymptomatic Mediastinal Lymphoma Survivors Years after Treatment Termination
Patients treated due to mediastinal lymphomas are at risk of cardiovascular complications, as they receive chemotherapy, usually containing anthracyclines, often combined with thoracic radiotherapy. The aim of this prospective study was to assess early asymptomatic cardiac dysfunction using resting...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10219019/ https://www.ncbi.nlm.nih.gov/pubmed/37240533 http://dx.doi.org/10.3390/jcm12103427 |
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author | Nabiałek-Trojanowska, Izabela Jankowska, Hanna Sławiński, Grzegorz Dąbrowska-Kugacka, Alicja Lewicka, Ewa |
author_facet | Nabiałek-Trojanowska, Izabela Jankowska, Hanna Sławiński, Grzegorz Dąbrowska-Kugacka, Alicja Lewicka, Ewa |
author_sort | Nabiałek-Trojanowska, Izabela |
collection | PubMed |
description | Patients treated due to mediastinal lymphomas are at risk of cardiovascular complications, as they receive chemotherapy, usually containing anthracyclines, often combined with thoracic radiotherapy. The aim of this prospective study was to assess early asymptomatic cardiac dysfunction using resting and dobutamine stress echocardiography (DSE) at least 3 years after the end of mediastinal lymphoma treatment. Two groups of patients were compared: those treated with chemoradiotherapy and those exclusively treated with chemotherapy. Left ventricular contractile reserve (LVCR) during DSE was assessed using changes in LV ejection fraction (LVEF), LV global longitudinal strain (LV GLS), and a novel parameter—Force, which is the ratio of the systolic blood pressure to the LV end-systolic volume. The study included 60 patients examined at a median of 89 months after the end of treatment. Resting echocardiography showed normal LVEF of 58.9 ± 9.6%, borderline LV GLS of −17.7 ± 3%, decreased mean stroke volume (SV) of 51.4 ± 17 mL, and indexed SV of 27.3 ± 8 mL/m(2), and the right ventricular free wall longitudinal strain (LS) was impaired in some patients but not in all. There were no significant differences between the groups, with the exception of arterial hypertension, which was more common in the chemotherapy group (32% vs. 62.5%, p = 0.04). In resting echocardiography, only LV posterior wall LS differed significantly and was impaired in patients treated with chemotherapy (−19.1 ± 3.1% vs. −16.5 ± 5.1%, p = 0.04). DSE, performed in 21 patients after a median of 166 months from the end of cancer treatment, detected new contractility disorders in 1 patient (4.8%) and decreased LVCR in the majority of patients when determined using changes in LVEF or LV GLS, and in all patients when assessed with changes in Force. Conclusions: Most asymptomatic mediastinal lymphoma survivors showed preserved ventricular function on resting echocardiography. However, all of them showed impaired LV contractile reserve on DSE, as assessed with a simple parameter—Force. This may indicate subtle LV dysfunction and confirms the need for long-term monitoring of patients with potentially cardiotoxic cancer treatment. |
format | Online Article Text |
id | pubmed-10219019 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-102190192023-05-27 Echocardiographic Findings in Asymptomatic Mediastinal Lymphoma Survivors Years after Treatment Termination Nabiałek-Trojanowska, Izabela Jankowska, Hanna Sławiński, Grzegorz Dąbrowska-Kugacka, Alicja Lewicka, Ewa J Clin Med Article Patients treated due to mediastinal lymphomas are at risk of cardiovascular complications, as they receive chemotherapy, usually containing anthracyclines, often combined with thoracic radiotherapy. The aim of this prospective study was to assess early asymptomatic cardiac dysfunction using resting and dobutamine stress echocardiography (DSE) at least 3 years after the end of mediastinal lymphoma treatment. Two groups of patients were compared: those treated with chemoradiotherapy and those exclusively treated with chemotherapy. Left ventricular contractile reserve (LVCR) during DSE was assessed using changes in LV ejection fraction (LVEF), LV global longitudinal strain (LV GLS), and a novel parameter—Force, which is the ratio of the systolic blood pressure to the LV end-systolic volume. The study included 60 patients examined at a median of 89 months after the end of treatment. Resting echocardiography showed normal LVEF of 58.9 ± 9.6%, borderline LV GLS of −17.7 ± 3%, decreased mean stroke volume (SV) of 51.4 ± 17 mL, and indexed SV of 27.3 ± 8 mL/m(2), and the right ventricular free wall longitudinal strain (LS) was impaired in some patients but not in all. There were no significant differences between the groups, with the exception of arterial hypertension, which was more common in the chemotherapy group (32% vs. 62.5%, p = 0.04). In resting echocardiography, only LV posterior wall LS differed significantly and was impaired in patients treated with chemotherapy (−19.1 ± 3.1% vs. −16.5 ± 5.1%, p = 0.04). DSE, performed in 21 patients after a median of 166 months from the end of cancer treatment, detected new contractility disorders in 1 patient (4.8%) and decreased LVCR in the majority of patients when determined using changes in LVEF or LV GLS, and in all patients when assessed with changes in Force. Conclusions: Most asymptomatic mediastinal lymphoma survivors showed preserved ventricular function on resting echocardiography. However, all of them showed impaired LV contractile reserve on DSE, as assessed with a simple parameter—Force. This may indicate subtle LV dysfunction and confirms the need for long-term monitoring of patients with potentially cardiotoxic cancer treatment. MDPI 2023-05-12 /pmc/articles/PMC10219019/ /pubmed/37240533 http://dx.doi.org/10.3390/jcm12103427 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Nabiałek-Trojanowska, Izabela Jankowska, Hanna Sławiński, Grzegorz Dąbrowska-Kugacka, Alicja Lewicka, Ewa Echocardiographic Findings in Asymptomatic Mediastinal Lymphoma Survivors Years after Treatment Termination |
title | Echocardiographic Findings in Asymptomatic Mediastinal Lymphoma Survivors Years after Treatment Termination |
title_full | Echocardiographic Findings in Asymptomatic Mediastinal Lymphoma Survivors Years after Treatment Termination |
title_fullStr | Echocardiographic Findings in Asymptomatic Mediastinal Lymphoma Survivors Years after Treatment Termination |
title_full_unstemmed | Echocardiographic Findings in Asymptomatic Mediastinal Lymphoma Survivors Years after Treatment Termination |
title_short | Echocardiographic Findings in Asymptomatic Mediastinal Lymphoma Survivors Years after Treatment Termination |
title_sort | echocardiographic findings in asymptomatic mediastinal lymphoma survivors years after treatment termination |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10219019/ https://www.ncbi.nlm.nih.gov/pubmed/37240533 http://dx.doi.org/10.3390/jcm12103427 |
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