INCREASED RISK OF HEART-VALVE REGURGITATION AFTER MEDIASTINAL RADIATION FOR HODGKINS-DISEASE - AN ECHOCARDIOGRAPHIC STUDY

Objective-To assess by echocardiography the occurrence and degree of l ate cardiac sequelae after Hodgkin's disease by chemotherapy. Patients and methods-In Norway from 1980 to 1988, 129 patients < 50 years old with Hodgkin's disease had curative treatment with mediastinal radiati on, with or without chemotherapy. 116 (90%) of these patients (mean (S D) age 37 (7) years, 67 males) were examined by echocardiography 5-13 years after treatment. 40 healthy individuals (mean (SD) age 40 (11), 20 males) were examined as controls. All those examined were in regula r sinus rhythm. Results-Grade > 1 (scale 0-3) aortic and/or mitral val var regurgitation was found in 24% of the patients (15% aortic, 7% mit ral, and 2% aortic+mitral), affecting 46% of the females v 16% of the males (P < 0.001). Female gender was a significant risk factor for aor tic and mitral regurgitation (odds ratio 4.7, 95% confidence interval 2.0 to 11.2), whereas age, period of follow up, radiation dose, and ch emotherapy were not. Thickened pericardium was diagnosed in 15% of the patients. No risk factors were identified. No cases of pericardial th ickening or valvar regurgitation grade > 1 were recorded in the contro l group. Mean values for measured and calculated indices of systolic a nd diastolic function were within the normal range for patients and co ntrols. The patients had reduced E/A ratio compared with the healthy c ontrols (E/A 1.1 v 2.0, P < 0.001). Conclusions-Abnormal left sided va lvar regurgitation was detected in one fourth of the patients, affecti ng the aortic valve in more than half of the cases. Females had an inc reased risk of valvar regurgitation. Echocardiographic screening after high-dose mediastinal radiation is recommended.