Radiation induced heart disease

Heart

Volumn 95, Issue 3, 2009, Pages 252-258

  Heidenreich, Paul A ^a,b,c   Kapoor, John R ^a  

^a STANFORD UNIVERSITY   (United States)

^b VA PALO ALTO HEALTH CARE SYSTEM   (United States)

^c 111C 3801 Miranda Avenue ^*  (United States)

Author keywords

[No Author keywords available]

Indexed keywords

AORTA STENOSIS; AORTA VALVE REGURGITATION; ARTICLE; HEART ARRHYTHMIA; HEART MUSCLE FIBROSIS; HODGKIN DISEASE; HUMAN; IRRADIATION; ISCHEMIC HEART DISEASE; MEDIASTINAL IRRADIATION; PERICARDITIS; PRIORITY JOURNAL; RADIATION DOSE; RADIATION INDUCED HEART DISEASE; TREATMENT DURATION;

CORONARY ARTERY DISEASE; CORONARY VESSELS; FEMALE; HEART; HUMANS; MALE; MEDIASTINAL NEOPLASMS; RADIATION INJURIES; RADIOTHERAPY; RISK ASSESSMENT;

EID: 62149087421     PISSN: 13556037     EISSN: 1468201X     Source Type: Journal    
DOI: 10.1136/hrt.2008.149088     Document Type: Article

References (20)

1. Selwyn AP. The cardiovascular system and radiation. Lancet 1983;ii:152-4. ▶ Selwyn discusses radiation induced heart disease from a historical perspective and some of the important studies suggesting that an association exists.
2. Carver JR, Shapiro CL, Ng A, et al, for the ASCO Cancer Survivorship Expert Panel. American Society of Clinical Oncology clinical evidence review on the ongoing care of adult cancer survivors: cardiac and pulmonary late effects. J Clin Oncol 2007;25:3991-4008. ▶ Carver and colleagues review the evidence on the incidence of long term cardiac or pulmonary toxicity secondary to chemotherapy, radiotherapy, or trastuzumab in cancer survivors.
3. Carmel RJ, Kaplan HS. Mantle irradiation in Hodgkin's disease. An analysis of technique, tumor eradication, and complications. Cancer 1976;37:2813-25. ▶ This article examines 377 Hodgkin's disease patients who received mantle irradiation. It is noted that the addition of a subcarinal block after 2500-3500 rads and the use of the thin lung block technique reduced the incidence of pulmonary and pericardial complications.
4. Hancock SL, Donaldson SS, Hoppe RT. Cardiac disease following treatment of Hodgkin's disease in children and adolescents. J Clin Oncol 1993;11:1208-15. ▶ This study reviewed records of 635 patients treated for Hodgkin's disease before 21 years of age between 1961 and 1991 and assessed the risks of cardiac disease. An increased risk of death from coronary artery and other cardiac diseases was found with mediastinal radiation of 40-45 Gy and the risk increased within 5 years of irradiation.
5. Fajardo LF, Stewart JR, Cohn KE. Morphology of radiationinduced heart disease. Arch Pathol 1968;86:512-9. ▶ This article discusses typical findings in radiation induced heart disease.
6. Morton DL, Glancy DL, Joseph WL, et al. Management of patients with radiation-induced pericarditis with effusion: a note on the development of aortic regurgitation in two of them. Chest 1973;64:291-7. ▶ Discusses the notion that pericardiectomy effectively relieves cardiac tamponade and probably prevents development of constrictive pericarditis. In 17 patients with radiation induced pericardial effusions and in whom subtotal pericardiectomy was performed, 12 were living and well without evidence of significant cardiac dysfunction up to 3 years after operation.
7. Heidenreich PA, Hancock SL, Lee BK, et al. Asymptomatic cardiac disease following mediastinal irradiation. J Am Coll Cardiol 2003;42:743-9. ▶ This study was designed to evaluate the utility of screening previously irradiated patients with echocardiography. The results demonstrated a high prevalence of asymptomatic heart disease and aortic valvular disease.
8. Heidenreich PA, Hancock SL, Vagelos RH, et al. Diastolic dysfunction after mediastinal irradiation. Am Heart J 2005;150:977-82. ▶ The study sought to determine the prevalence of diastolic dysfunction and its associated prognosis in asymptomatic patients after irradiation. Results demonstrated that there is a high prevalence of diastolic dysfunction, and its presence is associated with stress induced ischaemia and a worse prognosis.
9. Hequet O, Le QH, Moullet I, et al. Subclinical late cardiomyopathy after doxorubicin therapy for lymphoma in adults. J Clin Oncol 2004;22:1864-71. ▶ This study assessed the incidence and features of subclinical cardiotoxicity after treatment with doxorubicin for lymphoma. Results showed that cardiac abnormalities occurred in patients, even after moderate anthracycline doses. Risk factors for cardiomyopathy included male sex, older age, higher dose of doxorubicin, radiotherapy, and being overweight.
10. Carlson RG, Mayfield WR, Normann S, et al. Radiation-associated valvular disease. Chest 1991;99:538-45. ▶ This report describes the cases of three young patients with evidence of significant valvular disease following mediastinal irradiation and provides a review of the literature.
11. Hancock SL, Tucker MA, Hoppe RT. Factors affecting late mortality from heart disease after treatment of Hodgkin's disease. JAMA 1993;270:1949-55. ▶ This retrospective study assessed the risk of cardiovascular mortality after treatment in 2232 Hodgkin's disease patients. Mediastinal irradiation increased the risk of cardiovascular death. Risk was found to be higher with increasing irradiation doses, minimal blocking, young age, and increasing duration of follow-up.
12. Henry-Amar M, Hayat M, Meerwaldt JH, et al. Causes of death after therapy for early stage Hodgkin's disease entered on EORTC protocols. EORTC Lymphoma Cooperative Group. Int J Radiat Oncol Biol Phys 1990;19:1155-7. ▶ This study demonstrated that over long term follow-up, there was a progressive increase in the risk of dying from causes other than Hodgkin's. The authors suggest that the higher risk for death might be a consequence of treatment.
13. Paszat LF, Mackillop WJ, Groome PA, et al. Mortality from myocardial infarction after adjuvant radiotherapy for breast cancer in the surveillance, epidemiology, and end-results cancer registries. J Clin Oncol 1998;16:2625-31. ▶ Pazat and colleagues demonstrate that adjuvant radiation therapy for left sided breast cancer was associated with a higher risk for fatal myocardial infarction 10-15 years later compared with adjuvant radiation therapy for right sided breast cancer.
14. Boivin JF, Hutchison GB, Lubin JH, et al. Coronary artery disease mortality in patients treated for Hodgkin's disease. Cancer 1992;69:1241-7. ▶ Boivin and colleagues studied the association between mediastinal irradiation, chemotherapy, and mortality from coronary artery disease in 4665 patients treated for Hodgkin's disease over an average follow-up of 7 years. Overall, the results support the hypothesis that radiation therapy increases the risk of coronary artery disease.
15. Hicks GL Jr. Coronary artery operation in radiation-associated atherosclerosis: long-term follow-up. Ann Thorac Surg 1992;53:670-4. ▶ This study of 14 patients with coronary atherosclerosis due to irradiation demonstrated that patients have a low operative mortality but have risk of early right ventricular and pulmonary dysfunction. The authors note that use of the internal mammary artery may not be possible in all cases and recommend anterior pericardiectomy.
16. Gharagozloo F, Clements IP, Mullany CJ. Use of the internal mammary artery for myocardial revascularization in a patient with radiation-induced coronary artery disease. Mayo Clin Proc 1992;67:1081-4. ▶ Gharagozloo and colleagues describe a case of a 9-year-old boy with stage IIA Hodgkin's disease who underwent radiotherapy to the neck and mediastinum. On follow-up 22 years later, he was found to have proximally located high grade coronary artery stenoses and successfully underwent coronary artery bypass grafting.
17. van Son JA, Noyez L, van Asten WN. Use of internal mammary artery in myocardial revascularization after mediastinal irradiation. J Thorac Cardiovasc Surg 1992;104:1539-44. ▶ This study evaluated use of the internal mammary artery versus vein grafts in patients with radiation associated proximal coronary artery disease. Based on the findings, the authors conclude that the internal mammary artery should be considered as a viable conduit for revascularisation when preoperative assessment shows patency.
18. Schulman HE, Korr KS, Myers TJ. Left internal thoracic artery graft occlusion following mediastinal radiation therapy. Chest 1994;105:1881-2. ▶ This is a report of a 51-year-old man who underwent bypass surgery for severe multivessel coronary disease 18 years following mediastinal irradiation. One year later, he was found to have closure of the left internal thoracic artery graft. The authors conclude that a history of mediastinal radiation therapy may not assure the typically excellent long term patency of the internal thoracic artery graft.
19. Handa N, McGregor CG, Danielson GK, et al. Coronary artery bypass grafting in patients with previous mediastinal radiation therapy. J Thorac Cardiovasc Surg 1999;117:1136-42. ▶ This is a retrospective review of patients undergoing coronary artery bypass surgery after mediastinal irradiation. While early results of surgery were good, late survival was limited by malignancy and the development of heart failure. Notably, a number of patients were later diagnosed with valve disease and required valve surgery.
20. Heidenreich PA, Schnittger I, Strauss HW, et al. Screening for coronary artery disease after mediastinal irradiation for Hodgkin's disease. J Clin Oncol 2007;25:43-9. ▶ In a study of 294 outpatients, the authors evaluated whether stress imaging could identify unsuspected coronary stenoses in patients with a history of mediastinal irradiation for Hodgkin's disease. The authors concluded that stress induced signs of ischaemia and significant coronary artery disease were highly prevalent after mediastinal irradiation in young patients, and stress testing identified asymptomatic individuals at high risk for acute myocardial infarction or sudden cardiac death.