How to prevent and manage radiation-induced coronary artery disease

Research output: Contribution to journalReview article

3 Citations (Scopus)

Abstract

Radiation-induced coronary heart disease (RICHD) is the second most common cause of morbidity and mortality in patients treated with radiotherapy for breast cancer, Hodgkin's lymphoma and other prevalent mediastinal malignancies. The risk of RICHD increases with radiation dose. Exposed patients may present decades after treatment with manifestations ranging from asymptomatic myocardial perfusion defects to ostial, triple-vessel disease and sudden cardiac death. RICHD is insidious, with a long latency and a tendency to remain silent late into the disease course. Vessel involvement is often diffuse and is preferentially proximal. The pathophysiology is similar to that of accelerated atherosclerosis, characterised by the formation of inflammatory plaque with high collagen and fibrin content. The presence of conventional risk factors potentiates RICHD, and aggressive risk factor management should ideally be initiated prior to radiation therapy. Stress echocardiography is more sensitive and specific than myocardial perfusion imaging in the detection of RICHD, and CT coronary angiography shows promise in risk stratification. Coronary artery bypass grafting is associated with higher risks of graft failure, perioperative complications and all-cause mortality in patients with RICHD. In most cases, the use of drug-eluting stents is preferable to surgical intervention, bare metal stenting or balloon-angioplasty alone.

Original languageEnglish (US)
Pages (from-to)1647-1653
Number of pages7
JournalHeart
Volume104
Issue number20
DOIs
StatePublished - Oct 1 2018

Fingerprint

Coronary Artery Disease
Coronary Disease
Radiation
Radiotherapy
Stress Echocardiography
Myocardial Perfusion Imaging
Drug-Eluting Stents
Balloon Angioplasty
Mortality
Sudden Cardiac Death
Risk Management
Fibrin
Coronary Angiography
Hodgkin Disease
Coronary Artery Bypass
Atherosclerosis
Collagen
Perfusion
Metals
Breast Neoplasms

Keywords

  • cardiac catheterization and angiography
  • cardiac risk factors and prevention
  • coronary artery disease
  • percutaneous coronary intervention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

How to prevent and manage radiation-induced coronary artery disease. / Cuomo, Jason R.; Javaheri, Sean Payman; Sharma, Gyanendra Kumar; Kapoor, Deepak; Berman, Adam Eric; Weintraub, Neal Lee.

In: Heart, Vol. 104, No. 20, 01.10.2018, p. 1647-1653.

Research output: Contribution to journalReview article

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AU - Weintraub, Neal Lee

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