Radiation-Associated Valvular Disease
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VALVULAR HEART DISEASE (TL KIEFER, SECTION EDITOR)
Radiation-Associated Valvular Disease Samantha Xu 1 & Eoin Donnellan 1 & Milind Y. Desai 1,2 Accepted: 2 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review Radiation-associated valvular disease (RAVD) is characterized by late valvular manifestations following radiation exposure to the mediastinum. Review of current guidelines was performed to examine best practices to reduce risk and optimize outcomes in this patient population. Recent Findings Early and consistent screening and comprehensive and careful planning are critical in managing RAVD. Due to long latency periods, serial screening and targeted evaluation of risk factors are essential to early detection. Varying and complex presentations of RAVD require an integrated team of experienced specialists equipped with multimodality imaging-based screening protocols to stratify risk, plan intervention, and evaluate treatment response. Summary Patients with valvular manifestations associated with radiation therapy call for an individualized plan of care involving longitudinal multimodality imaging-based screening and experienced decision-making regarding timing and strategy of intervention to improve patient outcomes. Keywords Radiation-associated cardiac disease . Cancer . Radiation therapy . Cardio-oncology . Radiation-associated valvular disease
Introduction Radiation-associated cardiac disease (RACD) represents a late manifestation of radiation therapy (XRT) for various thoracic malignancies, including breast cancer, Hodgkin’s and nonHodgkin’s lymphoma, and lung and esophageal cancer [1•]. While advances in radiation and chemotherapeutic regimens over the past several decades have resulted in vastly improved long-term survival among patients with thoracic malignancies, this increased longevity has come at the cost of an increasing prevalence of RACD [2, 3]. This article is part of the Topical Collection on Valvular Heart Disease * Milind Y. Desai [email protected] Samantha Xu [email protected] Eoin Donnellan [email protected] 1
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
2
Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, OH, USA
Although the acute cardiac manifestations of XRT have been recognized since the beginning of the twentieth century when high-dose, wide-field mediastinal XRT was the norm, the longer-term cardiac implications have only come to light in recent years. This is due to a significant latency period between XRT and the cardiac manifestations of RACD [4]. Radiation-associated cardiac disease carries substantial healthcare implications, with an absolute risk of cardiac morbidity and mortality of 2% at 5 years and 23% at 20 years compared with non-irradiated patients [5]. In light of the heightened awareness of the cardiotoxic effects of XRT, modern radiation delivery techniques utilize a variety of techniques to mitigate the deleterious cardiac effects of therapy. These include provisions
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