Radiation-Induced Heart Disease: An Under-Recognized Entity?

Cardio-oncology (S Francis, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Cardio-oncology

Opinion statement

Radiation-induced heart disease (RIHD) represents a spectrum of cardiovascular disease in patients who have undergone mediastinal, thoracic, or breast radiotherapy (RT). RIHD may involve any cardiac structure and is a major cause of morbidity and mortality in cancer survivors. While large cohort studies have demonstrated that symptomatic RIHD is a common late finding in this population, the incidence of asymptomatic disease is likely to be even higher. Long-term follow-up with regular screening for RIHD plays an important role in the management of cancer survivors who have undergone RT. Aggressive modification of traditional cardiovascular risk factors such as hypertension, dyslipidemia, and cigarette smoking is essential in patients at risk for RIHD, as these have been shown to potentiate the risks of radiation. In patients with symptomatic RIHD, medical and/or percutaneous therapies are often preferable to surgical interventions in view of the increased surgical risk associated with radiation damage to surrounding tissues. Percutaneous revascularization should generally be favored over surgical revascularization. Transcatheter valve replacements have not been widely used in this population but may offer an alternative to high-risk surgical valve procedures. Pericardiectomy is usually associated with extremely poor short-term and long-term outcomes in patients with RIHD and should be avoided in most cases. Heart transplantation is also higher risk in patients with RIHD than in patients with other etiologies of heart failure, but may be considered in young patients without other comorbidities.

Keywords

Radiation therapy Radiation-induced heart disease Cardiovascular disease Coronary artery disease Valve disease Restrictive cardiomyopathy Pericardial disease Breast cancer Hodgkin lymphoma 

Notes

Compliance with Ethics Guidelines

Conflict of Interest

Dr. Margot Davis and Dr. Ronald M. Witteles each declare no potential conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Division of Cardiovascular MedicineStanford University School of MedicineStanfordUSA

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