Elsevier

JACC: CardioOncology

Volume 3, Issue 3, September 2021, Pages 360-380
JACC: CardioOncology

Mini-Focus Issue: Radiation and Cardiovascular Disease
State-of-the-Art Review
Cardiovascular Manifestations From Therapeutic Radiation: A Multidisciplinary Expert Consensus Statement From the International Cardio-Oncology Society

https://doi.org/10.1016/j.jaccao.2021.06.003Get rights and content
Under a Creative Commons license
open access

Highlights

  • Radiation therapy leads to short- and long-term cardiovascular adverse effects of the vasculature and the heart, including valvular, myocardial, and pericardial disease.

  • Computed tomography scans conducted for radiation planning or cancer staging provide an available opportunity to detect asymptomatic atherosclerosis and direct preventive therapies.

  • Additional practical screening recommendations for cardiovascular disease based on anatomical exposure are provided.

  • There are unique considerations in the management of radiation-induced cardiovascular disease; contemporary percutaneous treatment is often preferred over surgical options.

Abstract

Radiation therapy is a cornerstone of cancer therapy, with >50% of patients undergoing therapeutic radiation. As a result of widespread use and improved survival, there is increasing focus on the potential long-term effects of ionizing radiation, especially cardiovascular toxicity. Radiation therapy can lead to atherosclerosis of the vasculature as well as valvular, myocardial, and pericardial dysfunction. We present a consensus statement from the International Cardio-Oncology Society based on general principles of radiotherapy delivery and cardiovascular risk assessment and risk mitigation in this population. Anatomical-based recommendations for cardiovascular management and follow-up are provided, and a priority is given to the early detection of atherosclerotic vascular disease on imaging to help guide preventive therapy. Unique management considerations in radiation-induced cardiovascular disease are also discussed. Recommendations are based on the most current literature and represent a unanimous consensus by the multidisciplinary expert panel.

Key Words

cancer
cardiovascular disease
imaging
prevention
radiation therapy
screening

Abbreviations and Acronyms

aHR
adjusted hazard ratio
CABG
coronary artery bypass graft
CAC
coronary artery calcium
CAD
coronary artery disease
CI
confidence interval
CT
computed tomography
CTCA
computed tomography coronary angiography
CV
cardiovascular
DIBH
deep inspiratory breath hold
HF
heart failure
HL
Hodgkin lymphoma
HNC
head and neck cancer
HR
hazard ratio
LIMA
left internal mammary artery
MRI
magnetic resonance imaging
NT-proBNP
N-terminal pro–B-type natriuretic peptide
OR
odds ratio
PAD
peripheral arterial disease
RT
radiation therapy
SAVR
surgical aortic valve replacement
SVC
superior vena cava
TAVR
transcatheter aortic valve replacement
TTE
transthoracic echocardiogram

Cited by (0)

Tochukwu M. Okwuosa, DO, served as the Guest Editor-in-Chief for this paper.

The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the Author Center.

Drs. Lenihan and Dent contributed equally as senior authors.