Elsevier

American Heart Journal

Volume 150, Issue 5, November 2005, Pages 977-982
American Heart Journal

Clinical Investigation
Congestive Heart Failure
Diastolic dysfunction after mediastinal irradiation

https://doi.org/10.1016/j.ahj.2004.12.026Get rights and content

Background

Mediastinal irradiation is known to cause cardiac disease, but its effect on left ventricular diastolic function is unknown. The purpose of this study was to determine the prevalence of diastolic dysfunction and its association with prognosis in asymptomatic patients after mediastinal irradiation.

Methods

We recruited 294 patients who had received at least 35 Gy to the mediastinum for treatment of Hodgkin disease. Each patient underwent resting echocardiography, stress echocardiography, and nuclear scintigraphy. Survival free from cardiac events was determined during 3.2 years of follow-up.

Results

The mean age of the included patients was 42 years, and 49% were male. Adequate measurements of diastolic function were obtained in 282 (97%) patients. Diastolic dysfunction was considered mild in 26 (9%) and moderate in 14 (5%). Exercise-induced ischemia was more common in patients with diastolic dysfunction (23%) than those with normal diastolic function (11%, P = .008). After adjustment for patient demographics, clinical characteristics, and radiation history, patients with diastolic dysfunction had worse event-free survival than patients with normal function (hazard ratio 1.66, 95% CI 1.06-2.4).

Conclusions

There is a high prevalence of diastolic dysfunction in asymptomatic patients after mediastinal irradiation, and the presence of diastolic dysfunction is associated with stress-induced ischemia and a worse prognosis. Screening with Doppler echocardiography may be helpful in identifying patients at risk for subsequent cardiac events.

Section snippets

Patient population

Patients were eligible if they had received at least 35 Gy of mantle irradiation for treatment of Hodgkin disease, had no history of significant cardiac disease (a history of pacemaker implant, mitral valve prolapse, or transient pericarditis was allowed), and gave written consent to undergo noninvasive testing with echocardiography and nuclear scintigraphy. We identified eligible subjects by attempting to contact patients followed at Stanford University Medical Center who were not known to

Results

Of 335 eligible patients treated at Stanford, 254 (76%) were recruited into the echocardiographic study. An additional 40 patients treated elsewhere were included for a total of 294. There were no significant differences in demographics between the contacted and referral populations; however, the referral population had received slightly less mantle irradiation. Diastolic function could not be estimated in 12 (3%) of 294 patients because of E and A fusion (n = 5) or inability to measure

Discussion

Diastolic dysfunction is now recognized as a common cause of heart failure and poor outcome even in patients with preserved left ventricular ejection fraction.8., 13. Our study found a high rate of diastolic dysfunction in asymptomatic patients after mediastinal irradiation. We also found that patients with diastolic function had worse cardiac event-free survival and were more likely to have stress-induced ischemia than patients with normal function.

The cause of diastolic dysfunction after

References (17)

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The study was supported by grant 1 RO1 CA 63001 from the National Cancer Institute, National Institutes of Health. PAH is supported by a Career Development Award from the Veteran's Affairs Health Services Research Development Office.

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