Elevated resting heart rate is a marker of subclinical left ventricular dysfunction in hodgkin lymphoma survivors

Abstract

Background Thoracic irradiation is one of the cornerstones of Hodgkin lymphoma (HL) treatment, which contributes to high rates of long-term survivorship, but begets a life-long increased risk of heart disease including heart failure. At the cardio-oncology (CO) clinic, persistent sinus tachycardia or elevated resting heart rate (RHR) is frequently observed in these patients. The aim of this study was to evaluate the relation between RHR and left ventricular (LV) dysfunction. Methods In 75 HL survivors visiting our CO-clinic echocardiographic evaluation of LV systolic and diastolic function including global longitudinal strain (GLS) was performed to assess subclinical LV dysfunction. Results Median age of HL diagnosis was 24 [25th-75th percentile: [19] , [29] ] years with a 17 [12] , [25] year interval to CO-clinic visit and 31 patients (41%) were male. Average RHR was 78 ± 14 bpm and 40% of patients (N = 30) had an elevated RHR defined as ≥ 80 bpm. While there was no difference in LV ejection fraction (55.6 ± 4.3 vs . 54.8 ± 6.6; p = 0.543), patients with elevated RHR had abnormal GLS (-15.9% vs . −18.3%, p = 0.045) and higher prevalence of diastolic dysfunction (73.3% vs . 46.7%; p = 0.022). GLS, E/e’ ratio and presence of diastolic dysfunction were independently associated with RHR when correcting for age, sex and mantle field irradiation. A significant improvement was observed of the RHR-association model with solely extracardiac confounders when LV-function parameters were added to the model (F-statistic = 6.36, p = 0.003). Conclusions This study indicates RHR as a possible marker for subclinical LV-dysfunction in HL survivors.

Characteristics of patients with newly diagnosed hematological malignancies referred for echocardiography

“…In the world of cardio-oncology growing attention is being paid to cardiac arrhythmias, mainly atrial fibrillation ( 31 , 32 ). Cardiac arrhythmias, especially atrial fibrillation and other tachyarrhythmias, may indicate subclinical left ventricle dysfunction in hemato-oncology ( 33 ). The complex proarrhythmic mechanism in this group of patients results from water and electrolyte disorders, advanced age, coexisting cardiovascular diseases, and the direct effect of anticancer drugs ( 34 ).…”

Higher pre-treatment skin sympathetic nerve activity and elevated resting heart rate after chemoradiotherapy predict worse esophageal cancer outcomes

“…Autonomic dysregulation is thought to be one of the most important factors. RHR reflects the balance between vagal and sympathetic systems [ 7 ], with elevated RHR indicating increased sympathetic activation and autonomic dysregulation [ 1 , 6 , 8 ]. Sympathetic nerve activation is linked not only to tumorigenesis, tumor proliferation and metastasis but also to arrhythmogenesis and cardiovascular events [ 1 , 9 , 10 ], hence, the sympathetic system might influence heart rate and tumor mortality simultaneously while on the other hand, the severity of tumors also reflects on sympathetic tone.…”

Impaired Global Longitudinal Strain Is Associated with Cardiovascular Events in Hodgkin Lymphoma Survivors

“…As CHL is mostly diagnosed at a young age, it is important to monitor cardiac function in these patients, and long-term follow-up including echocardiographic screening is recommended, preferably starting around 10 years after CHL diagnosis [11,24]. An increasing number of studies describe findings on echocardiographic changes after thoracic irradiation [25,26], including left ventricular (LV) diastolic and systolic dysfunction [25]. LV systolic function is usually assessed by left ventricular ejection fraction (LVEF) [27].…”