Review

Radiation-induced heart disease: A practical guide to diagnosis and management

Eoin Donnellan, MD, Dermot Phelan, MD, PhD, Cian P. McCarthy, MD, Patrick Collier, MD, PhD, Milind Desai, MD and Brian Griffin, MD
Cleveland Clinic Journal of Medicine December 2016, 83 (12) 914-922; DOI: https://doi.org/10.3949/ccjm.83a.15104

Article Figures & Data

Figures

  • FIGURE 1
    FIGURE 1

    Three-dimensional echocardiography in a patient with radiation-induced aortic stenosis demonstrates a typical pattern of thickening and calcification affecting the aorto- mitral curtain (arrows) and the anterior mitral valve leaflet.

Tables

  • TABLE 1

    Risk factors for radiation-induced heart disease

    Anterior or left chest irradiation location
    High cumulative dose of radiation (> 30 Gy)
    Younger age (< 50) at time of radiation therapy
    High dose of radiation fractions (> 2 Gy/day)
    Presence and extent of tumor in or next to the heart
    Inadequate or absent shielding
    Concomitant chemotherapy (eg, anthracyclines)
    Cardiovascular risk factors
    Preexisting cardiovascular disease
  • TABLE 2

    Cardiac screening before and after radiotherapy

    Before radiotherapy
    Comprehensive screening and aggressive risk-factor modification
    Baseline transthoracic echocardiography to detect cardiac anomalies
    Annual follow-up
    Cardiovascular history and examination
    Transthoracic echocardiography if murmur detected
    Careful investigation of symptoms
    5-Year follow-up
    Transthoracic echocardiography for high-risk asymptomatic patients (Table 1)
    Noninvasive coronary artery disease assessment with stress echocardiography or stress cardiac magnetic resonance imaging
    Repeat transthoracic echocardiography at 5-year intervals
    10-Year follow-up
    Transthoracic echocardiography for asymptomatic non-high-risk patients
    Repeat transthoracic echocardiography every 5 years thereafter

    • Adapted from the European Association of Cardiovascular Imaging and the American Society of Echocardiography, information in reference 10.

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