Impaired Right Ventricular Function in Long-Term Lymphoma Survivors

Abstract

Background: Cardiotoxicity from anthracyclines or cardiac radiation therapy is detrimental to left ventricular (LV) function. However, the long-term effects on right ventricular (RV) performance are largely unknown. The aim of this study was to investigate the long-term impact of cardiotoxic treatment on RV function among adult cancer survivors.

Methods: Adult lymphoma survivors (LSs) who underwent autologous hematopoietic stem cell transplantation in Norway from 1987 to 2008 were invited to undergo cardiovascular evaluation by echocardiography and cardiopulmonary exercise testing. In total, 274 LSs participated. The mean age was 56 ± 12 years, and the mean follow-up time since lymphoma diagnosis was 13 ± 6 years. Echocardiographic parameters were compared with those of age- and gender-matched control subjects from an existing large Norwegian database. RV systolic dysfunction was indicated by two or more abnormal RV systolic parameters according to current recommendations. LV systolic dysfunction was indicated by LV global longitudinal strain > -17%.

Results: All parameters of RV systolic function were impaired in LSs compared with control subjects (P < .01 for all). The most pronounced difference was observed for tricuspid annular plane systolic excursion: 22.9 ± 4.1 versus 27.1 ± 4.2 mm. Greater cardiotoxic treatment burden was associated with larger RV functional impairment. Tricuspid annular plane systolic excursion correlated with peak oxygen consumption (r = 0.23, P = .001). RV systolic performance was associated with LV systolic function (r = 0.49, P < .001 for tricuspid annular plane systolic excursion vs LV global longitudinal strain), but a greater proportion of patients had LV dysfunction (30.8%) compared with RV dysfunction (6.2%) (P < .001).

Conclusions: RV systolic function was impaired in LSs. The association between RV and LV function indicates a global, long-term cardiotoxic effect. However, RV dysfunction was less prevalent than LV dysfunction.

Keywords: Anthracyclines; Echocardiography; Lymphoma survivors; Radiotherapy; Right ventricle.