TY - JOUR
T1 - How to prevent and manage radiation-induced coronary artery disease
AU - Cuomo, Jason R.
AU - Javaheri, Sean P.
AU - Sharma, Gyanendra K.
AU - Kapoor, Deepak
AU - Berman, Adam E.
AU - Weintraub, Neal L.
N1 - Funding Information:
Funding This work was supported by National Institutes of Health grants HL112640, HL126949, HL134354 and AR070029 to NLW.
Publisher Copyright:
© 2018 Article author(s).
PY - 2018/10/1
Y1 - 2018/10/1
N2 - 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.
AB - 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.
KW - cardiac catheterization and angiography
KW - cardiac risk factors and prevention
KW - coronary artery disease
KW - percutaneous coronary intervention
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U2 - 10.1136/heartjnl-2017-312123
DO - 10.1136/heartjnl-2017-312123
M3 - Review article
C2 - 29764968
AN - SCOPUS:85047964937
SN - 1355-6037
VL - 104
SP - 1647
EP - 1653
JO - Heart
JF - Heart
IS - 20
ER -