Echocardiographic evaluation of early and chronic cardiotoxicity in adult patients treated for Hodgkin’s disease with ABVD regimen
Abstract:
The prospective study was conducted to determine whether standard regimen ABVD used in the treatment of Hodgkin’s disease is accompanied by the presence of early and chronic myocardial impairment. The study comprised 52 patients (30 male and 22 female) aged 34±15 years (range 18–71; median 30) with Hodgkin’s disease and the control group with 40 healthy volunteers (21 male and 19 female) aged 40±8 years (range 20–70; median 38). The maximal administered cumulative dose (CD) of doxorubicin was 297±50 mg/m2 (range 150–450; median 300). Radiotherapy of the mediastinum was delivered to 27 (52%) patients with a mean dose 41±4 Gy (range 30–46; median 42). Echocardiography was performed at baseline and before each course of chemotherapy. The control examination was done at one month after the treatment and after one year. The stress echocardiography was performed at one-year control. Significant change of ejection fraction (EF) during the treatment was observed only in 10 (18%) patients (7 male/3 female) aged 29±13 years (range 18–56; median 22). The mean toxic CD of doxorubicin was 170±33 mg/m2 (range 100–200; median 175) and the mean time of the onset EF decline was 13.3±3 weeks (range 8–16; median 14). These changes were asymptomatic, and all patients completed the treatment successfully. Four patients (8%) demonstrated significant asymptomatic decline of EF after the chemotherapy. When compared the value of EF after one-year examination, a stable significant decline of EF in the sub-group with early toxicity was found. Despite a difference in the rest EF, the exercise increment of EF did not reveal any significant difference among tested groups and the contractile reserve of the left ventricle in patients was not impaired. The present data shows that the treatment of Hodgkin’s disease with the standard ABVD regimen is accompanied with mild early and chronic asymptomatic changes of the left ventricular function. These changes were not reversible during one-year follow-up.