Key result
Among patients with symptomatic heart disease after thoracic radiotherapy, complex cardiac disease was frequent, with 48% requiring cardiac surgery and 24% dying during follow-up.
Observational (n=25)
Symptomatic heart disease developing long-term after thoracic radiotherapy is associated with complex multi-structural cardiac involvement and a high mortality rate.
Post-radiotherapy symptomatic heart disease signals high surgical need and mortality; leaves open prospective trials on prevention and management.
Background: Thoracic radiotherapy (RT), especially with past technology, may affect the heart, but rarely leads to symptoms. In patients with symptomatic heart disease after RT, outcome seems to be dismal. Methods: In this observational descriptive study, clinical characteristics, findings of ECG, echocardiography, cardiac interventions and follow-up were analysed in patients with prior RT and symptomatic heart disease. The patients were identified in the echocardiography database during a ten year period. Results: There were 25 patients who had thoracic RT at a median age of 35 years (range: 9–59) for lymphoma (12 patients), breast cancer (9) or other cancer (4). At least likely inclusion of the heart in the target volume of previous RT was present in of 16 of 20 patients with detailed information on RT. Last follow-up was 24 years (range: 5–57) after RT at a median age of 56 years (range: 30–84). Symptoms (≥1 per patient) included: dyspnea (21 patients), angina (12) and/or heart failure (10). Three patients had prior myocardial infarction. The following disease was found: moderate valvular disease in 19 patients (76%), coronary artery disease in 12 (48%), abnormal ECG in 18 (72%), relevant conduction system disease in 9 (36%), restriction / constriction in 7 (28%), and pericardial effusion in 4 (16%). Cardiac surgery was necessary in 12 patients (death in 2 patients), percutaneous coronary interventions in 5 and pacemaker implantation in 3. Endocarditis occurred in 2 patients. During follow-up (21 ± 8 months), death occurred in 6 patients (24%) and was due to heart disease in 5 of them. Conclusions: If symptomatic heart disease develops in the long-term follow-up after RT, complex disease of valves, coronary arteries, conduction system, myocardium and pericardium is frequently observed. Cardiac interventions are often necessary; and heart disease may be a common cause of death in these patients. Careful assessment and evaluation of treatment options are needed in this patient group.
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Jost et al. (2007) conducted an observational in Symptomatic heart disease after thoracic radiotherapy (n=25). Thoracic radiotherapy was evaluated on Clinical characteristics, cardiac interventions, and mortality. Among patients with symptomatic heart disease after thoracic radiotherapy, complex cardiac disease was frequent, with 48% requiring cardiac surgery and 24% dying during follow-up.
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