Date of download: 7/2/2016 Copyright © The American College of Cardiology. All rights reserved. From: Abnormal Exercise Response in Long-Term Survivors of Hodgkin Lymphoma Treated With Thoracic Irradiation: Evidence of Cardiac Autonomic Dysfunction and Impact on Outcomes J Am Coll Cardiol. 2015;65(6): doi: /j.jacc Autonomic Dysfunction in Radiation Survivors Cardiovascular consequences of radiation therapy (RT) contributing to increased cardiovascular morbidity and mortality in survivors of Hodgkin lymphoma. RT patients have increased prevalence of elevated resting heart rate and abnormal heart rate recovery relative to controls. These abnormalities contribute to decreased exercise tolerance, and abnormal heart rate recovery is associated with increased mortality among RT patients. AV = atrioventricular; SA = sinoatrial. Figure Legend:

Date of download: 7/2/2016 Copyright © The American College of Cardiology. All rights reserved. From: Abnormal Exercise Response in Long-Term Survivors of Hodgkin Lymphoma Treated With Thoracic Irradiation: Evidence of Cardiac Autonomic Dysfunction and Impact on Outcomes J Am Coll Cardiol. 2015;65(6): doi: /j.jacc Frequency Distribution Histograms and Kernel Density Plots Frequency distribution histograms (blue bars) and kernel density plots (red broken curves) for (A) resting heart rate (HR) and (B) heart rate recovery (HRR) at 1 minute for control and radiation cohorts. Radiation patients had a higher resting HR and a lower HRR at 1 min after completion of exercise compared with control subjects. Normal distribution curves (solid salmon curves) are included. Figure Legend:

Date of download: 7/2/2016 Copyright © The American College of Cardiology. All rights reserved. From: Abnormal Exercise Response in Long-Term Survivors of Hodgkin Lymphoma Treated With Thoracic Irradiation: Evidence of Cardiac Autonomic Dysfunction and Impact on Outcomes J Am Coll Cardiol. 2015;65(6): doi: /j.jacc Heart Rate and Systolic Blood Pressure Response to Exercise Heart rate (HR) (A) and systolic blood pressure (SBP) (B) response to exercise in the radiation and control cohorts. Radiation patients had a higher HR and a blunted SBP response during all stages of exercise and recovery compared with control subjects. Values are presented as mean ± standard error for each cohort before, during, and after exercise. Stages 1 through 4 refer to stages of the Bruce exercise protocol. For HR, 1 min Rec. and 3 min Rec. refer to 1 and 3 min of recovery after completion of exercise. For SBP, ≤3 min Rec. and 5 min Rec. refer to measurements within 3 min of terminating exercise and at 5 min of recovery, respectively. **p ≤ and ***p < , by Student t test without adjustments for repeated measures. Figure Legend:

Date of download: 7/2/2016 Copyright © The American College of Cardiology. All rights reserved. From: Abnormal Exercise Response in Long-Term Survivors of Hodgkin Lymphoma Treated With Thoracic Irradiation: Evidence of Cardiac Autonomic Dysfunction and Impact on Outcomes J Am Coll Cardiol. 2015;65(6): doi: /j.jacc Prevalence of Elevated Resting Heart Rate and Abnormal Heart Rate Recovery Prevalence of an elevated resting heart rate (HR) and abnormal heart rate recovery (HRR) across tertiles of time interval from completion of radiation therapy (RT) to exercise treadmill test (ETT). The prevalence of elevated resting HR and abnormal HRR increased with time from RT to ETT in radiation patients. *Probability values are based on Mantel-Haenszel chi-square trend test. Figure Legend:

Date of download: 7/2/2016 Copyright © The American College of Cardiology. All rights reserved. From: Abnormal Exercise Response in Long-Term Survivors of Hodgkin Lymphoma Treated With Thoracic Irradiation: Evidence of Cardiac Autonomic Dysfunction and Impact on Outcomes J Am Coll Cardiol. 2015;65(6): doi: /j.jacc Kaplan-Meier Cumulative Survival Curves Kaplan-Meier cumulative survival curves for normal (blue) and abnormal (red) heart rate recovery (HRR) at 1 min after termination of exercise. Abnormal HRR was associated with increased all-cause mortality. Figure Legend: