Co-incidence of significant coronary calcifications in patients with radiotherapy-associated valvular disease

Background In cancer survivors, radiotherapy, particularly thoracic radiotherapy, is linked to an increased risk of cardiovascular diseases, including radiotherapy-associated valve disease. Radiotherapy is also associated with an increased risk of coronary heart disease. The co-occurrence of radiotherapy associated valve disease and radiotherapy-associated coronary heart disease is underexplored. Given the growing number of long-term cancer survivors, understanding this relationship is valuable in identifying patients that would benefit from coronary imaging or functional testing when radiotherapy-associated valvular disease is detected on echocardiography. Methods Patients with radiotherapy-associated valvular disease presenting to our cardio-oncology outpatient clinic were included in this study. This includes patients that have a history of thoracic radiotherapy and valve disease consistent with radiotherapy-associated damage. Available thoracic CT imaging data was analyzed for coronary calcifications according to the guidelines on coronary artery calcium scoring of noncontrast noncardiac chest CT-scans [1]. Briefly, each vessel (LM, LAD, LCX, RCA) was visually scored from 0 (none) to 3 (severe) based on the presence of calcifications in <1/3 (1), 1/3-2/3 (=2) or >2/3 (=3) of the vessel. The score was then added up with a maximum score of 12. Results 44 patients with radiotherapy-associated valvular disease and interpretable CT imaging were included in the study (mean age 65 ± 12.4 years, 61% male, 39% female). The total calcium scores were as follows; none in 27% (n = 12), mild in 23% (n =10), moderate in 9% (n = 4) and severe in 41% (n = 18). Altogether 50% of patients had moderate to severe coronary calcium scores (Table 1). Conclusion Half of all patients with radiotherapy-associated valvular disease had moderate to severe coronary artery calcifications according to noncontrast, noncardiac chest CT scans. This increased pre-test probability should be considered when evaluating coronary imaging or functional testing in patients in whom radiotherapy-associated valvular disease is detected during routine echocardiography.