CARDIAC DISEASE AFTER CHEST IRRADIATION FOR HODGKINS-DISEASE - INCIDENCE IN 108 PATIENTS WITH LONG FOLLOW-UP

Occult or overt but delayed cardiac disease after thoracic radiotherap y for Hodgkin's disease may be common. Detailed cardiac evaluation was performed in 108 patients, mean age 46 +/- 6.2 years, with Hodgkin's disease at 175 +/- 43 months after irradiation. The study protocol inc luded clinical examination, graded treadmill exercise test and echocar diography. Some patients with angina pectoris, previous myocardial inf arction and an abnormal ECG were studied by thallium-201 scintigraphy, cardiac catheterization and coronary angiography. Cardiac disease was found in 12 patients (11%). Three patients had angina pectoris, one p atient had myocardial infarction, two complained of dyspnea on effort and two had congestive heart failure. At catheterization, constrictive pericarditis was diagnosed in four patients; in two additional patien ts an occult constrictive pericarditis was found. One patient had both mitral and tricuspidal regurgitation and one had mitral regurgitation alone. Eight patients (7.4%) had severe coronary artery disease; four of these had associated constrictive pericarditis. Four patients had a pericardiectomy and another four had undergone coronary artery by-pa ss graft. Two patients died after operation from persistant pericardia l constriction. It is concluded that the incidence of delayed cardiac disease after radiotherapy is relatively high; chronic pericardial dis orders and coronary artery disease are the most frequent manifestation s of this disease. Standard surgical treatment may be beneficial becau se of the relative youth of these patients.