Skip to main content

Advertisement

Log in

Cardiovascular sequelae of radiation therapy

  • Review
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Radiotherapy (RT) is one of the main therapeutic options for malignancy treatment; nevertheless, RT is not free from side effects, including an increased risk for secondary neoplasms and other organs injury. Cardiovascular complications are the second most frequent fatal post-RT sequelae, which physicians should be aware of and ready to diagnose early and cure. This review therefore aims to examine epidemiology, pathogenesis and clinical dose-correlated manifestations of RT-induced cardiovascular disease. Future perspectives on screening, prevention and treatment are also provided.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Whelan TJ, Julian J, Wright J, Jadad AR, Levine ML (2000) Does locoregional radiation therapy improve survival in breast cancer? A Meta-Analysis. JCO 18:1220–1229

    CAS  Google Scholar 

  2. Matthiesen C, Thompson JS, De La Fuente Herman T, Ahmad S, Herman T (2012) Use of stereotactic body radiation therapy for medically inoperable multiple primary lung cancer. J Med Imaging Radiat Oncol 56:561–566

    PubMed  Google Scholar 

  3. Bonner JA, Harari PM, Giralt J, Azarnia N, Shin DM, Cohen RB, Jones CU, Sur R, Raben D, Jassem J, Ove R, Kies MS, Baselga J, Youssoutian H, Amellal N, Rowinsky EK, Ang KK (2006) Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med 13:567–578

    Google Scholar 

  4. Fermé C, Eghbali H, Meerwaldt JH, Rieux C, Bosq J, Berger F, Girinsky T, Brice P, van’t Veer MB, Walewski JA, Lederlin P, Tirelli U, Carde P, Van den Neste E, Gyan E, Monconduit M, Diviné M, Raemaekers JM, Salles G, Noordijk EM, Creemers GJ, Gabarre J, Hagenbeek A, Reman O, Blanc M, Thomas J, Vié B, Kluin-Nelemans JC, Viseu F, Baars JW, Poortmans P, Lugtenburg PJ, Carrie C, Jaubert J, Henry-Amar M, EORTC-GELA H8 Trial (2007) Chemotherapy plus involved-field radiation in early-stage Hodgkin’s disease. N Engl J Med 357:1916–1927

    PubMed  Google Scholar 

  5. Savage KJ (2006) Primary mediastinal large B-cell lymphoma. Oncologist 11:488–495

    CAS  PubMed  Google Scholar 

  6. Jaworski C, Mariani JA, Wheeler G, Kaye DM (2013) Cardiac complications of thoracic irradiation. J Am Coll Cardiol 61:2319–2328

    PubMed  Google Scholar 

  7. Darby SC, Ewertz M, McGale P, Bennet AM, Blom-Goldman U, Brønnum D, Correa C, Cutter D, Gagliardi G, Gigante B, Jensen MB, Nisbet A, Peto R, Rahimi K, Taylor C, Hall P (2013) Risk of ischemic heart disease in women after radiotherapy for breast cancer. N Engl J Med 368:987–998

    CAS  PubMed  Google Scholar 

  8. Bhatti P, Sigurdson AJ, Mabuchi K (2008) Can low-dose radiation increase risk of cardiovascular disease? Lancet 372:697–699

    PubMed  Google Scholar 

  9. Stewart FA (2012) Mechanisms and dose-response relationships for radiation-induced cardiovascular disease. Ann ICRP 41:72–79

    CAS  PubMed  Google Scholar 

  10. Boerma M (2012) Experimental radiation-induced heart disease: past, present, and future. Radiat Res 178:1–6

    CAS  PubMed Central  PubMed  Google Scholar 

  11. Stewart FA, Akleyev AV, Hauer-Jensen M, Hendry JH, Kleiman NJ, Macvittie TJ, Aleman BM, Edgar AB, Mabuchi K, Muirhead CR, Shore RE, Wallace WH (2012) ICRP publication 118: ICRP statement on tissue reactions and early and late effects of radiation in normal tissues and organs–threshold doses for tissue reactions in a radiation protection context. Ann ICRP 41:1–322

    CAS  PubMed  Google Scholar 

  12. Schneider JS, Edwards JE (1979) Irradiation-induced pericarditis. Chest 75:560–564

    CAS  PubMed  Google Scholar 

  13. Adams MJ, Hardenbergh PH, Constine LS, Lipshultz SE (2003) Radiation-associated cardiovascular disease. Crit Rev Oncol Hematol 45:55–75

    PubMed  Google Scholar 

  14. Lee MS, Finch W, Mahmud E (2013) Cardiovascular complications of radiotherapy. Am J Cardiol 112:1688–1696

    PubMed  Google Scholar 

  15. Cwikiel M, Albertsson M, Hambraeus G (1994) Acute and delayed effects of radiotherapy in patients with oesophageal squamous cell carcinoma treated with chemotherapy, surgery and pre- and postoperative radiotherapy. Acta Oncol 33:49–53

    CAS  PubMed  Google Scholar 

  16. Travis LB, Ng AK, Allan JM, Pui CH, Kennedy AR, Xu XG, Purdy JA, Applegate K, Yahalom J, Constine LS, Gilbert ES, Boice JD Jr (2012) Second malignant neoplasms and cardiovascular disease following radiotherapy. J Natl Cancer Inst 104:357–370

    CAS  PubMed Central  PubMed  Google Scholar 

  17. Correa CR, Litt HI, Hwang WT, Ferrari VA, Solin LJ, Harris EE (2007) Coronary artery findings after left-sided compared with right-sided radiation treatment for early-stage breast cancer. J Clin Oncol 25:3031–3037

    PubMed  Google Scholar 

  18. Yusuf SW, Sami S, Daher IN (2011) Radiation-induced heart disease: a clinical update. Cardiol Res Pract 2011:317659

    PubMed Central  PubMed  Google Scholar 

  19. Boivin JF, Hutchison GB, Lubin JH, Mauch P (1992) Coronary artery disease mortality in patients treated for Hodgkin’s disease. Cancer 69:1241–1247

    CAS  PubMed  Google Scholar 

  20. Hancock SL, Donaldsson SS, Hoppe RT (1993) Cardiac disease following treatment of Hodgkin’s disease in children and adolescents. J Clin Oncol 11:1208–1215

    CAS  PubMed  Google Scholar 

  21. Tukenova M, Guibout C, Oberlin O, Doyon F, Mousannif A, Haddy N, Guérin S, Pacquement H, Aouba A, Hawkins M, Winter D, Bourhis J, Lefkopoulos D, Diallo I, de Vathaire F (2010) Role of cancer treatment in long-term overall and cardiovascular mortality after childhood cancer. J Clin Oncol 28:1308–1315

    PubMed  Google Scholar 

  22. Mulrooney DA, Yeazel MW, Kawashima T, Mertens AC, Mitby P, Stovall M, Donaldson SS, Green DM, Sklar CA, Robison LL, Leisenring WM (2009) Cardiac outcomes in a cohort of adult survivors of childhood and adolescent cancer: retrospective analysis of the Childhood Cancer Survivor Study cohort. BMJ 339:b4606

    PubMed Central  PubMed  Google Scholar 

  23. Annest LS, Anderson RP, Li W, Hafermann MD (1983) Coronary artery disease following mediastinal radiation therapy. J Thorac Cardiovasc Surg 85:257–263

    CAS  PubMed  Google Scholar 

  24. Fukada J, Shigematsu N, Takeuchi H, Ohashi T, Saikawa Y, Takaishi H, Hanada T, Shiraishi Y, Kitagawa Y, Fukuda K (2013) Symptomatic pericardial effusion after chemoradiation therapy in esophageal cancer patients. Int J Radiat Oncol Biol Phys 87:487–493

    PubMed  Google Scholar 

  25. Heidenreich PA, Kapoor JR (2009) Radiation induced heart disease: systemic disorders in heart disease. Heart 95:252–258

    PubMed  Google Scholar 

  26. Wondergem J, Boerma M, Kodama K, Stewart FA, Trott KR (2013) Cardiovascular effects after low-dose exposure and radiotherapy: what research is needed? Radiat Environ Biophys 52:425–434

    PubMed  Google Scholar 

  27. Schellong G, Riepenhausen M, Bruch C, Kotthoff S, Vogt J, Bölling T, Dieckmann K, Pötter R, Heinecke A, Brämswig J, Dörffel W (2010) Late valvular and other cardiac diseases after different doses of mediastinal radiotherapy for Hodgkin disease in children and adolescents: report from the longitudinal GPOH follow-up project of the German-Austrian DAL-HD studies. Pediatr Blood Cancer 55:1145–1152

    PubMed  Google Scholar 

  28. Howard-Flanders P, Wright EA (1955) Effect of oxygen on the radiosensitivity of growing bone and a possible danger in the use of oxygen during radiotherapy. Nature 175:428–429

    CAS  PubMed  Google Scholar 

  29. Churchill-Davidson I (1960) Oxygen effect on radiosensitivity. Cancer 13:122–132

    Google Scholar 

  30. Goodhead DT (1994) Initial events in the cellular effects of ionizing radiations: clustered damage in DNA. Int J Radiat Biol 65:7–17

    CAS  PubMed  Google Scholar 

  31. Kiyohara H, Ishizaki Y, Suzuki Y, Katoh H, Hamada N, Ohno T, Takahashi T, Kobayashi Y, Nakano T (2011) Radiation-induced ICAM-1 expression via TGF-β1 pathway on human umbilical vein endothelial cells; comparison between X-ray and carbon-ion beam irradiation. J Radiat Res 52:287–292

    CAS  PubMed  Google Scholar 

  32. Weintraub NL, Jones WK, Manka D (2010) Understanding radiation-induced vascular disease. J Am Coll Cardiol 55:1237–1239

    CAS  PubMed  Google Scholar 

  33. Young EF, Smilenov LB (2011) Impedance-based surveillance of transient permeability changes in coronary endothelial monolayers after exposure to ionizing radiation. Radiat Res 176:415–424

    CAS  PubMed  Google Scholar 

  34. Boerma M, Kruse JJ, van Loenen M, Klein HR, Bart CI, Zurcher C, Wondergem J (2004) Increased deposition of von Willebrand factor in the rat heart after local ionizing irradiation. Strahlenther Onkol 180:109–116

    PubMed  Google Scholar 

  35. Chargari C (2013) The issue of radiation-induced cardiovascular toxicity: preclinical highlights and perspectives on preventive strategies. Biomed J 36:150–151

    PubMed  Google Scholar 

  36. Halle M, Gabrielsen A, Paulsson-Berne G (2010) Sustained inflammation due to nuclear factor-kappa B activation in irradiated human arteries. J Am Coll Cardiol 55:1227–1236

    CAS  PubMed  Google Scholar 

  37. Sridharan V, Tripathi P, Sharma SK, Moros EG, Corry PM, Lieblong BJ, Kaschina E, Unger T, Thöne-Reineke C, Hauer-Jensen M, Boerma M (2012) Cardiac inflammation after local irradiation is influenced by the kallikrein-kinin system. Cancer Res 72:4984–4992

    CAS  PubMed Central  PubMed  Google Scholar 

  38. Halle M, Hall P, Tornvall P (2011) Cardiovascular disease associated with radiotherapy: activation of nuclear factor kappa-B. J Intern Med 269:469–477

    CAS  PubMed  Google Scholar 

  39. Zaho W, Robbins ME (2009) Inflammation and chronic oxidative stress in radiation-induced late normal injury: therapeutic implication. Curr Med Chem 16:130–143

    Google Scholar 

  40. Stewart FA, Heeneman S, Te Poele J, Kruse J, Russell NS, Gijbels M, Daemen M (2006) Ionizing radiation accelerates the development of atherosclerotic lesions in ApoE−/− mice and predisposes to an inflammatory plaque phenotype prone to hemorrhage. Am J Pathol 168:649–658

    CAS  PubMed Central  PubMed  Google Scholar 

  41. Schaue D, Kachikwu EL, McBride WH (2012) Cytokines in radiobiological responses: a review. Radiat Res 178:505–523

    PubMed Central  PubMed  Google Scholar 

  42. Kusunoki Y, Hayashi T (2008) Long-lasting alterations of the immune system by ionizing radiation exposure: implications for disease development among atomic bomb survivors. Int J Radiat Biol 84:1–14

    CAS  PubMed  Google Scholar 

  43. Hayashi T, Morishita Y, Khattree R, Misumi M, Sasaki K, Hayashi I, Yoshida K, Kajimura J, Kyoizumi S, Imai K, Kusunoki Y, Nakachi K (2012) Evaluation of systemic markers of inflammation in atomic-bomb survivors with special reference to radiation and age effects. FASEB J 26:4765–4773

    CAS  PubMed Central  PubMed  Google Scholar 

  44. Lee CL, Moding EJ, Cuneo KC, Li Y, Sullivan JM, Mao L, Washington I, Jeffords LB, Rodrigues RC, Ma Y, Das S, Kontos CD, Kim Y, Rockman HA, Kirsch DG (2012) p53 functions in endothelial cells to prevent radiation-induced myocardial injury in mice. Sci Signal 5:ra52

    PubMed Central  PubMed  Google Scholar 

  45. Fajardo LF, Berthrong M (1988) Vascular lesions following radiation. Pathol Annu 23(Pt 1):297–330

    PubMed  Google Scholar 

  46. Ross R (1993) The pathogenesis of atherosclerosis: a perspective for the 1990s. Nature 362:801–809

    CAS  PubMed  Google Scholar 

  47. Suwaidi JA, Hamasaki S, Higano ST, Nishimura RA, Holmes DR Jr, Lerman A (2000) Long-term follow-up of patients with mild coronary artery disease and endothelial dysfunction. Circulation 101:948–954

    CAS  PubMed  Google Scholar 

  48. Veeragandham RS, Goldin MD (1998) Surgical management of radiation-induced heart disease. Ann Thorac Surg 65:1014–1019

    CAS  PubMed  Google Scholar 

  49. Korosoglou G, Kristen AV, Andrassy M, Katus HA, Hardt SE (2012) Severe left main coronary stenosis in a young female patient, 6 years after mediastinal radiation therapy for non-Hodgkin lymphoma: assessment by coronary angiography and intravascular ultrasound. Clin Res Cardiol 101:317–320

    PubMed  Google Scholar 

  50. Notaristefano S, Giombolini C, Santucci S, Fortunati F, Del Pinto M, Tritto I, Notaristefano A, Ambrosio G (2003) Radiation induced ostial stenosis of the coronary artery as a cause of acute coronary syndromes: a novel mechanism of thrombus formation? Ital Heart J 4:341–344

    PubMed  Google Scholar 

  51. Waqar S, Jutley R, Mount R (2009) Bilateral coronary ostial disease following mediastinal irradiation: a case report. Cases J 2:7792

    PubMed Central  PubMed  Google Scholar 

  52. Kaski JC (2003) Atheromatous plaque location and arterial remodelling. Eur Heart J 24:291–293

    CAS  PubMed  Google Scholar 

  53. Gonzalo N, Garcia-Garcia HM, Regar E, Barlis P, Wentzel J, Onuma Y, Ligthart J, Serruys PW (2009) In vivo assessment of high-risk coronary plaques at bifurcations with combined intravascular ultrasound and optical coherence tomography. J Am Coll Cardiol: Cardiovasc Imaging 2:473–482

    Google Scholar 

  54. Cheruvu PK, Finn AV, Gardner C, Caplan J, Goldstein J, Stone GW, Virmani R, Muller JE (2007) Frequency and distribution of thin-cap fibroatheroma and ruptured plaques in human coronary arteries: a pathologic study. J Am Coll Cardiol 50:940–949

    PubMed  Google Scholar 

  55. Tribble DL, Barcellos-Hoff MH, Chu BM, Gong EL (1999) Ionizing radiation accelerates aortic lesion formation in fat fed mice via SOD inhibitable processes. Arterioscler Thromb Vasc Biol 19:1387–1392

    CAS  PubMed  Google Scholar 

  56. Hull MC, Morris CG, Pepine CJ, Mendenhall NP (2003) Valvular dysfunction and carotid, subclavian, and coronary artery disease in survivors of Hodgkin Lymphoma treated with radiation therapy. JAMA 290:2831–2837

    CAS  PubMed  Google Scholar 

  57. Gaya AM, Ashford RF (2005) Cardiac complications of radiation therapy. Clin Oncol (R Coll Radiol) 17:153–159

    CAS  Google Scholar 

  58. Fokkema M, den Hartog AG, van Lammeren GW, Bots ML, Pasterkamp G, Vink A, Moll FL, de Borst GJ (2012) Radiation-induced carotid stenotic lesions have a more stable phenotype than de novo atherosclerotic plaques. Eur J Vasc Endovasc Surg 43:643–648

    CAS  PubMed  Google Scholar 

  59. Imbalzano E, Trapani G, Creazzo M, Lizio G, Saitta A (2013) Coronary artery disease in radiotherapy. Int J Cardiol 168:e125–e126

    CAS  PubMed  Google Scholar 

  60. Filopei J, Frishman W (2012) Radiation-induced heart disease. Cardiol Rev 20:184–188

    PubMed  Google Scholar 

  61. Baker JE, Moulder JE, Hopewell JW (2011) Radiation as a risk factor for cardiovascular disease. Antioxid Redox Signal 15:1945–1956

    CAS  PubMed Central  PubMed  Google Scholar 

  62. Marks LB, Yu X, Prosnitz RG, Zhou SM, Hardenbergh PH, Blazing M, Hollis D, Lind P, Tisch A, Wong TZ, Borges-Neto S (2005) The incidence and functional consequences of RT-associated cardiac perfusion defects. Int J Radiat Oncol Biol Phys 63:214–223

    PubMed  Google Scholar 

  63. Prosnitz RG, Hubbs JL, Evans ES, Zhou SM, Yu X, Blazing MA, Hollis DR, Tisch A, Wong TZ, Borges-Neto S, Hardenbergh PH, Marks LB (2007) Prospective assessment of radiotherapy-associated cardiac toxicity in breast cancer patients: analysis of data 3 to 6 years after treatment. Cancer 110:1840–1850

    PubMed  Google Scholar 

  64. Baker JE, Fish BL, Su J, Haworth ST, Strande JL, Komorowski RA, Migrino RQ, Doppalapudi A, Harmann L, Allen Li X, Hopewell JW, Moulder JE (2009) 10 Gy total body irradiation increases risk of coronary sclerosis, degeneration of heart structure and function in a rat model. Int J Radiat Biol 85:1089–1100

    CAS  PubMed Central  PubMed  Google Scholar 

  65. Erven K, Florian A, Slagmolen P, Sweldens C, Jurcut R, Wildiers H, Voigt JU, Weltens C (2013) Subclinical cardiotoxicity detected by strain rate imaging up to 14 months after breast radiation therapy. Int J Radiat Oncol Biol Phys 85:1172–1178

    PubMed  Google Scholar 

  66. Johnson LK, Longenecker JP, Fajardo LF (1982) Differential radiation response of cultured endothelial cells and smooth myocytes. Anal Quant Cytol 4:188–198

    CAS  PubMed  Google Scholar 

  67. Dossing M, Rasmussen S, Fischer Hansen B (1977) Radiation-induced lesions of the aorta. Br Med J 1:973

    CAS  PubMed Central  PubMed  Google Scholar 

  68. Santoro F, Ferraretti A, Centola A, Cuculo A, Totaro A, Cocco D, Di Biase M, Brunetti ND (2013) Early clinical presentation of diffuse, severe, multi-district atherosclerosis after radiation therapy for Hodgkin lymphoma. Int J Cardiol 165:373–374

    PubMed  Google Scholar 

  69. Patel DA, Kochanski J, Suen AW, Fajardo LF, Hancock SL, Knox SJ (2006) Clinical manifestations of noncoronary atherosclerotic vascular disease after moderate dose irradiation. Cancer 106:718–725

    PubMed  Google Scholar 

  70. Fajardo LF (2005) The pathology of ionizing radiation as defined by morphologic patterns. Acta Oncol 44:13–22

    PubMed  Google Scholar 

  71. Murros KE, Toole JF (1989) The effect of radiation on carotid arteries: a review article. Arch Neurol 46:449–455

    CAS  PubMed  Google Scholar 

  72. Zidar N, Ferluga D, Hvala A, Popović M, Soba E (1997) Contribution to the pathogenesis of radiation-induced injury to large arteries. J Laryngol Otol 111:988–990

    CAS  PubMed  Google Scholar 

  73. Lam WW, Leung SF, So NM, Wong KS, Liu KH, Ku PK, Yuen HY, Metreweli C (2001) Incidence of carotid stenosis in nasopharyngeal carcinoma patients after radiotherapy. Cancer 92:2357–2363

    CAS  PubMed  Google Scholar 

  74. Dorresteijn LD, Kappelle AC, Scholz NM, Munneke M, Scholma JT, Balm AJ, Bartelink H, Boogerd W (2005) Increased carotid wall thickening after radiotherapy on the neck. Eur J Cancer 41:1026–1030

    PubMed  Google Scholar 

  75. Huang CC, Huang TL, Hsu HC, Chen HC, Lin HC, Chien CY, Fang FM, Chang HW, Tsai NW, Chang WN, Chen SF, Lin TK, Tan TY, Chang CR, Wang HC, Lin WC, Lu CH (2013) Long-term effects of neck irradiation on cardiovascular autonomic function: a study in nasopharyngeal carcinoma patients after radiotherapy. Muscle Nerve 47:344–350

    PubMed  Google Scholar 

  76. Sharabi Y, Dendi R, Holmes C, Goldstein DS (2003) Baroreflex failure as a late sequela of neck irradiation. Hypertension 42:110–116

    CAS  PubMed  Google Scholar 

  77. Plummer C, Henderson RD, O’Sullivan JD, Read SJ (2011) Ischemic stroke and transient ischemic attack after head and neck radiotherapy: a review. Stroke 42:2410–2418

    PubMed  Google Scholar 

  78. Dorth JA, Patel PR, Broadwater G, Brizel DM (2014) Incidence and risk factors of significant carotid artery stenosis in asymptomatic survivors of head and neck cancer after radiotherapy. Head Neck 36:215–219

    PubMed  Google Scholar 

  79. Imazio M, Adler Y (2013) Treatment with aspirin, NSAID, corticosteroids, and colchicine in acute and recurrent pericarditis. Heart Fail Rev 18:355–360

    CAS  PubMed  Google Scholar 

  80. Santoro F, Ieva R, Lupo P, Pellegrino PL, Correale M, Di Biase M, Brunetti ND (2012) Late calcification of the mitral-aortic junction causing transient complete atrio-ventricular block after mediastinal radiation of Hodgkin lymphoma: multimodal visualization. Int J Cardiol 155:e49–e50

    PubMed  Google Scholar 

  81. Nadlonek AN, Weyant MJ, Yu JA, Cleveland JC Jr, Reece TB, Meng X, Fullerton DA (2012) Radiation induces osteogenesis in human aortic valve interstitial cells. J Thorac Cardiovasc Surg 144:1466–1470

    CAS  PubMed Central  PubMed  Google Scholar 

  82. Wethal T, Lund MB, Edvardsen T, Fosså SD, Pripp AH, Holte H, Kjekshus J, Fosså A (2009) Valvular dysfunction and left ventricular changes in Hodgkin’s lymphoma survivors: a longitudinal study. Br J Cancer 101:575–581

    CAS  PubMed Central  PubMed  Google Scholar 

  83. Toutouzas K, Benetos G, Stefanadis C (2013) Ischemic heart disease after breast cancer radiotherapy. N Engl J Med 368:2524–2525

    PubMed  Google Scholar 

  84. Li F, Wang X, Capasso JM, Gerdes AM (1996) Rapid transition of cardiac myocytes from hyperplasia to hypertrophy during postnatal development. J Mol Cell Cardiol 28:1737–1746

    CAS  PubMed  Google Scholar 

  85. Stewart JR, Fajardo LF, Gillette SM, Constine LS (1995) Radiation injury to the heart. Int J Radiat Oncol Biol Phys 31:1205–1211

    CAS  PubMed  Google Scholar 

  86. Boerma M, Bart CI, Wondergem J (2002) Effects of ionizing radiation on gene expression in cultured rat heart cells. Int J Radiat Biol 78:219–225

    CAS  PubMed  Google Scholar 

  87. Mukherjee D, Coates PJ, Rastogi S, Lorimore SA, Wright EG (2013) Radiation-induced bone marrow apoptosis, inflammatory bystander-type signaling and tissue cytotoxicity. Int J Radiat Biol 89:139–146

    CAS  PubMed  Google Scholar 

  88. Rombouts C, Aerts A, Beck M, De Vos WH, Van Oostveldt P, Benotmane MA, Baatout S (2013) Differential response to acute low dose radiation in primary and immortalized endothelial cells. Int J Radiat Biol 89:841–850

    CAS  PubMed  Google Scholar 

  89. Schultheiss HP, Kühl U, Cooper LT (2011) The management of myocarditis. Eur Heart J 32:2616–2625

    PubMed  Google Scholar 

  90. Dogan SM, Bilici HM, Bakkal H, Aydin M, Karabag T, Sayin MR, Aktop Z (2012) The effect of radiotherapy on cardiac function. Coron Artery Dis 23:146–154

    PubMed  Google Scholar 

  91. Vasic N, Stevic R, Pesut D, Jovanovic D (2011) Acute left bundle branch block as a complication of brachytherapy for lung cancer. Respir Med 105(Suppl 1):S78–S80

    PubMed  Google Scholar 

  92. Ichinose T, Nakazato Y, Miyano H, Kimura T, Yamashita H, Takizawa K, Kawai S, Daida H, Kawasaki S, Amano A (2005) Severe infundibular pulmonary stenosis and coronary artery stenosis with ventricular tachycardia 24 years after mediastinal irradiation. Intern Med 44:963–966

    PubMed  Google Scholar 

  93. Makkar A, Prisciandaro J, Agarwal S, Lusk M, Horwood L, Moran J, Fox C, Hayman JA, Ghanbari H, Roberts B, Belardi D, Latchamsetty R, Crawford T, Good E, Jongnarangsin K, Bogun F, Chugh A, Oral H, Morady F, Pelosi F Jr (2012) Effect of radiation therapy on permanent pacemaker and implantable cardioverter-defibrillator function. Heart Rhythm 9:1964–1968

    PubMed  Google Scholar 

  94. Hurkmans CW, Knegjens JL, Oei BS, Maas AJ, Uiterwaal GJ, van der Borden AJ, Ploegmakers MM, van Erven L (2012) Management of radiation oncology patients with a pacemaker or ICD: a new comprehensive practical guideline in The Netherlands. Dutch Society of Radiotherapy and Oncology (NVRO). Radiat Oncol 7:198

    PubMed Central  PubMed  Google Scholar 

  95. Zaremba T, Jakobsen AR, Thøgersen AM, Riahi S, Kjaergaard B (2013) Effects of high-dose radiotherapy on implantable cardioverter defibrillators: an in vivo porcine study. Pacing Clin Electrophysiol 36:1558–1563

    PubMed  Google Scholar 

  96. Hudson F, Coulshed D, D’Souza E, Baker C (2010) Effect of radiation therapy on the latest generation of pacemakers and implantable cardioverter defibrillators: a systematic review. J Med Imaging Radiat Oncol 54:53–61

    CAS  PubMed  Google Scholar 

  97. Ron E, Brenner A (2010) Non-malignant thyroid diseases after a wide range of radiation exposures. Radiat Res 174:877–888

    CAS  PubMed Central  PubMed  Google Scholar 

  98. Ashizawa K, Imaizumi M, Usa T, Tominaga T, Sera N, Hida A, Ejima E, Neriishi K, Soda M, Ichimaru S, Nakashima E, Fujiwara S, Maeda R, Nagataki S, Eguchi K, Akahoshi M (2010) Metabolic cardiovascular disease risk factors and their clustering in subclinical hypothyroidism. Clin Endocrinol 72:689–695

    CAS  Google Scholar 

  99. Biondi B (2007) Cardiovascular effects of mild hypothyroidism. Thyroid 17:625–630

    CAS  PubMed  Google Scholar 

  100. Hsieh CH, Chiou WY, Lee CC, Lee MS, Lin HY, Su YC, Hung SK (2013) Factors affecting myocardial infarction in cervical cancer patients: a population-based study. J Clin Med Res 5:467–474

    PubMed Central  PubMed  Google Scholar 

  101. Lenarczyka M, Lam V, Jensen E, Fish BL, Su J, Koprowski S, Komorowski RA, Harmann L, Migrino RQ, Li XA, Hopewell JW, Moulderd JW, Baker JE (2013) Cardiac injury after 10 Gy total body irradiation: indirect role of effects on abdominal organs. Radiat Res 180:247–258

    Google Scholar 

  102. Curigliano G, Cardinale D, Suter T, Plataniotis G, de Azambuja E, Sandri MT, Criscitiello C, Goldhirsch A, Cipolla C, Roila F, ESMO Guidelines Working Group (2012) Cardiovascular toxicity induced by chemotherapy, targeted agents and radiotherapy: ESMO Clinical Practice Guidelines. Ann Oncol 23(Suppl 7):vii155–vii166

    PubMed  Google Scholar 

  103. Lancellotti P, Nkomo VT, Badano LP, Bergler J, Bogaert J, Davin L, Cosyns B, Coucke P, Dulgheru R, Edvardsen T, Gaemperli O, Galderisi M, Griffin B, Heidenreich PA, Nieman K, Plana JC, Port SC, Scherrer-Crosbie M, Schwartz RG, Sebag IA, Voigt JU, Wann S, Yang PC (2013) European Society of Cardiology Working Groups on Nuclear Cardiology and Cardiac Computed Tomography and Cardiovascular Magnetic Resonance; American Society of Nuclear Cardiology, Society for Cardiovascular Magnetic Resonance, and Society of Cardiovascular Computed Tomography. Expert consensus for multi-modality imaging evaluation of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr 26:1013–32103

    PubMed  Google Scholar 

  104. Lange SA, Ebner B, Wess A, Kögel M, Gajda M, Hitschold T, Jung J (2012) Echocardiography signs of early cardiac impairment in patients with breast cancer and trastuzumab therapy. Clin Res Cardiol 101:415–426

    CAS  PubMed  Google Scholar 

  105. Huey-Ru T, Ola G, Torgeir W, Haugaa KH, Fosså A, Fosså SD, Edvardsen T (2011) Left ventricular function assessed by two-dimensional speckle tracking echocardiography in long-term survivors of Hodgkin’s lymphoma treated by mediastinal radiotherapy with or without anthracycline therapy. Am J Cardiol 107:472–477

    Google Scholar 

  106. Chang M, Suh J, Kirtani V, Dobrescu A, Haas J, Zeldis S, Shayani S, Hindenburg AA (2013) Coronary calcium scanning in patients after adjuvant radiation for early breast cancer and ductal carcinoma in situ. Front Oncol 3:253

    PubMed Central  PubMed  Google Scholar 

  107. Boerma M, Hauer-Jensen M (2010) Potential targets for intervention in radiation-induced heart disease. Curr Drug Targets 11:1405–1412

    CAS  PubMed Central  PubMed  Google Scholar 

  108. Kouvaris JR, Kouloulias VE, Vlahos LJ (2007) Amifostine: the first selective-target and broad-spectrum radioprotector. Oncologist 12:738–747

    CAS  PubMed  Google Scholar 

  109. Hoving S, Seemann I, Visser NL, te Poele JA, Stewart FA (2013) Thalidomide is not able to inhibit radiation-induced heart disease. Int J Radiat Biol 89:685–691

    CAS  PubMed  Google Scholar 

  110. Hoving S, Heeneman S, Gijbels MJ, te Poele JA, Bolla M, Pol JF, Simons MY, Russell NS, Daemen MJ, Stewart FA (2010) NO-donating aspirin and aspirin partially inhibit age-related atherosclerosis but not radiation-induced atherosclerosis in ApoE null mice. PLoS ONE 5:e12874

    PubMed Central  PubMed  Google Scholar 

  111. Hoving S, Heeneman S, Gijbels MJ, te Poele JA, Pol JF, Gabriels K, Russel NS, Daemen MJ, Stewart FA (2011) Anti-inflammatory and anti-thrombotic intervention strategies using atorvastatin, clopidogrel and knock-down of CD40L do not modify radiation-induced atherosclerosis in ApoE null mice. Radiother Oncol 101:100–108

    CAS  PubMed  Google Scholar 

  112. Handa N, McGregor CG, Danielson GK, Orszulak TA, Mullany CJ, Daly RC, Dearani JA, Anderson BJ, Puga FJ (1999) Coronary artery bypass grafting in patients with previous mediastinal radiation therapy. J Thorac Cardiovasc Surg 117:1136–1142

    CAS  PubMed  Google Scholar 

  113. Renner SM, Massel D, Moon BC (1999) Mediastinal irradiation: a risk factor for atherosclerosis of the internal thoracic arteries. Can J Cardiol 15:597–600

    CAS  PubMed  Google Scholar 

  114. Schömig K, Ndrepepa G, Mehilli J, Pache J, Kastrati A, Schömig A (2007) Thoracic radiotherapy in patients with lymphoma and restenosis after coronary stent placement. Catheter Cardiovasc Interv 70:359–365

    PubMed  Google Scholar 

  115. Fokkema M, den Hartog AG, Bots ML, van der Tweel I, Moll FL, de Borst GJ (2012) Stenting versus surgery in patients with carotid stenosis after previous cervical radiation therapy: systematic review and meta-analysis. Stroke 43:793–801

    PubMed  Google Scholar 

  116. Imazio M, Brucato A, Cemin R, Ferrua S, Maggiolini S, Beqaraj F, Demarie D, Forno D, Ferro S, Maestroni S, Belli R, Trinchero R, Spodick DH, Adler Y, ICAP investigators (2013) A randomized trial of colchicine for acute pericarditis. N Engl J Med 369:1522–1528

    CAS  PubMed  Google Scholar 

  117. Maisch B, Ristic A, Pankuweit S (2010) Evaluation and management of pericardial effusion in patients with neoplastic disease. Prog Cardiovasc Dis 53:157–163

    PubMed  Google Scholar 

  118. Barbetakis N, Xenikakis T, Paliouras D, Asteriou C, Samanidis G, Kleontas A, Lafaras C, Platogiannis D, Bischiniotis T, Tsilikas C (2010) Pericardiectomy for radiation-induced constrictive pericarditis. Hellenic J Cardiol 51:214–218

    PubMed  Google Scholar 

  119. Pai VB, Nahata MC (2000) Cardiotoxicity of chemotherapeutic agents: incidence, treatment and prevention. Drug Saf 22:263–302

    CAS  PubMed  Google Scholar 

  120. Di Cosimo S (2011) Heart to heart with trastuzumab: a review on cardiac toxicity. Target Oncol 6:189–195

    PubMed  Google Scholar 

  121. Aydiner A (2013) Meta-analysis of breast cancer outcome and toxicity in adjuvant trials of aromatase inhibitors in postmenopausal women. Breast 22:121–129

    PubMed  Google Scholar 

  122. Cuppone F, Bria E, Verma S, Pritchard KI, Gandhi S, Carlini P, Milella M, Nisticò C, Terzoli E, Cognetti F, Giannarelli D (2008) Do adjuvant aromatase inhibitors increase the cardiovascular risk in postmenopausal women with early breast cancer? Meta-analysis of randomized trials. Cancer 112:260–267

    CAS  PubMed  Google Scholar 

  123. Reis SE, Costantino JP, Wickerham DL, Tan-Chiu E, Wang J, Kavanah M (2001) Cardiovascular effects of tamoxifen in women with and without heart disease: breast cancer prevention trial. J Natl Cancer Inst 93:16–21

    CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Natale Daniele Brunetti.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Santoro, F., Tarantino, N., Pellegrino, P.L. et al. Cardiovascular sequelae of radiation therapy. Clin Res Cardiol 103, 955–967 (2014). https://doi.org/10.1007/s00392-014-0718-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-014-0718-y

Keywords

Navigation