Author + information
- Received May 13, 2014
- Revision received November 2, 2014
- Accepted November 4, 2014
- Published online February 17, 2015.
- John D. Groarke, MBBCh, MPH∗,†,‡,
- Varsha K. Tanguturi, MD∗,
- Jon Hainer, BS†,
- Josh Klein, BA†,
- Javid J. Moslehi, MD∗,‡,
- Andrea Ng, MD§,
- Daniel E. Forman, MD∗,†,
- Marcelo F. Di Carli, MD∗,† and
- Anju Nohria, MD∗,‡∗ ()
- ∗Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- †Noninvasive Cardiovascular Imaging Program, Department of Medicine (Cardiovascular Division) and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
- ‡Cardio-Oncology Program, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Boston, Massachusetts
- §Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women’s Hospital, Boston, Massachusetts
- ↵∗Reprint requests and correspondence:
Dr. Anju Nohria, Division of Cardiovascular Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts 02115-6110.
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.
- abnormal heart rate recovery
- cardiac autonomic dysfunction
- elevated resting heart rate
- Hodgkin lymphoma
- radiation therapy
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 13, 2014.
- Revision received November 2, 2014.
- Accepted November 4, 2014.
- American College of Cardiology Foundation