Abnormal Exercise Response in Long-Term Survivors of Hodgkin Lymphoma Treated With Thoracic Irradiation

Abstract Background Hodgkin lymphoma (HL) survivors treated with thoracic radiation therapy (RT) have impaired exercise tolerance and increased cardiovascular mortality. Objectives The purpose of this study was to evaluate the prevalence of autonomic dysfunction and its implications on exercise capa...

Full description

Saved in:

Bibliographic Details
Published in:	Journal of the American College of Cardiology 2015-02, Vol.65 (6), p.573-583
Main Authors:	Groarke, John D., MBBCh, MPH, Tanguturi, Varsha K., MD, Hainer, Jon, BS, Klein, Josh, BA, Moslehi, Javid J., MD, Ng, Andrea, MD, Forman, Daniel E., MD, Di Carli, Marcelo F., MD, Nohria, Anju, MD
Format:	Article
Language:	eng
Subjects:	abnormal heart rate recovery Blood pressure cardiac autonomic dysfunction Cardiovascular Cardiovascular disease Drug therapy elevated resting heart rate Heart attacks Hodgkin lymphoma Internal Medicine Mortality prognosis radiation therapy
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Abstract Background Hodgkin lymphoma (HL) survivors treated with thoracic radiation therapy (RT) have impaired exercise tolerance and increased cardiovascular mortality. Objectives The purpose of this study was to evaluate the prevalence of autonomic dysfunction and its implications on exercise capacity and mortality in long-term survivors of HL. Methods Exercise parameters in 263 HL survivors referred for exercise treadmill testing at a median interval of 19 years after RT were compared with 526 age-, sex-, and cardiovascular risk score–matched control subjects. Within the RT cohort, the presence of autonomic dysfunction, defined by an elevated resting heart rate (HR) (≥80 beats/min) and abnormal heart rate recovery (HRR) at 1 min (≤12 beats/min if active cool-down, or ≤18 beats/min if passive recovery), was correlated with exercise capacity and all-cause mortality over a median follow-up of 3 years. Results RT was associated with elevated resting HR and abnormal HRR after adjusting for age, sex, cardiovascular risk factors, medications, and indication for exercise treadmill testing: odds ratio: 3.96 (95% confidence interval [CI]: 2.52 to 6.23) and odds ratio: 5.32 (95% CI: 2.94 to 9.65), respectively. Prevalence of autonomic dysfunction increased with radiation dose and time from RT. Both elevated resting HR and abnormal HRR were associated with reduced exercise capacity in RT patients. Abnormal HRR was also associated with increased all-cause mortality (age-adjusted hazard ratio: 4.60 [95% CI: 1.62 to 13.02]). Conclusions Thoracic RT is associated with autonomic dysfunction, as measured by elevated resting HR and abnormal HRR. These abnormalities are associated with impaired exercise tolerance, and abnormal HRR predicts increased all-cause mortality in RT patients.
ISSN:	0735-1097 1558-3597