What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Asymptomatic cardiac disease following mediastinal irradiation (n=294). Intervention: Mediastinal irradiation >20 years prior vs. Mediastinal irradiation <10 years prior. Primary outcome: Mild or greater aortic regurgitation (p=<0.0001).

What question did this study set out to answer?

To evaluate the prevalence of asymptomatic cardiac disease and the potential benefit of screening with echocardiography in previously irradiated patients.

June 25, 2026

Asymptomatic cardiac disease following mediastinal irradiation

Q: What question did this study set out to answer?

To evaluate the prevalence of asymptomatic cardiac disease and the potential benefit of screening with echocardiography in previously irradiated patients.

Key Result

Mediastinal irradiation >20 years prior was associated with a significantly higher prevalence of mild or greater aortic regurgitation compared to irradiation <10 years prior (60% vs. 4%, p<0.0001).

Key Points

To evaluate the prevalence of asymptomatic cardiac disease and the potential benefit of screening with echocardiography in previously irradiated patients.
Recruited 294 asymptomatic patients treated with mediastinal irradiation for Hodgkin's disease.
Conducted electrocardiography and transthoracic echocardiography on each patient.
Compared cardiac diseases in patients based on the time elapsed since irradiation.
60% of patients treated over 20 years ago had mild or greater aortic regurgitation versus 4% treated within 10 years (p < 0.0001).
16% of long-term irradiated patients had aortic stenosis compared to 0% in recent treatment (p = 0.0008).
Mildly reduced left ventricular fractional shortening was found in 36% of irradiated patients compared to 3% in the Framingham Heart Study.

Study Design

Type

Cross-Sectional (n=294)

Structured PICO

Does screening echocardiography detect asymptomatic cardiac disease in patients previously treated with mediastinal irradiation for Hodgkin's disease?

Population

294 asymptomatic patients (mean age 42 years, 51% female) treated with at least 35 Gy to the mediastinum for Hodgkin's disease.

Exposure

Screening with electrocardiography and transthoracic echocardiography

Comparator

Framingham Heart Study population (for left ventricular parameters) and internal comparison by time since irradiation (<10 years vs >20 years)

Outcome

Prevalence of asymptomatic cardiac disease (valvular disease, left ventricular fractional shortening, left ventricular mass)surrogate

Screening echocardiography reveals a high prevalence of asymptomatic heart disease, particularly aortic valvular disease, in patients with a history of mediastinal irradiation.

Main Result

Absolute Event Rate: 60% vs 4%

p-value: p=<0.0001

Abstract

OBJECTIVES: This study was designed to evaluate the potential benefit of screening previously irradiated patients with echocardiography. BACKGROUND: Mediastinal irradiation is known to cause cardiac disease. However, the prevalence of asymptomatic cardiac disease and the potential for intervention before symptom development are unknown. METHODS: We recruited 294 asymptomatic patients (mean age 42 +/- 9 years, 49% men, mean mantle irradiation dose 43 +/- 0.3 Gy) treated with at least 35 Gy to the mediastinum for Hodgkin's disease. After providing written consent, each patient underwent electrocardiography and transthoracic echocardiography. Valvular disease was common and increased with time following irradiation. Patients who had received irradiation more than 20 years before evaluation had significantly more mild or greater aortic regurgitation (60% vs. 4%, p < 0.0001), moderate or greater tricuspid regurgitation (4% vs. 0%, p = 0.06), and aortic stenosis (16% vs. 0%, p = 0.0008) than those who had received irradiation within 10 years. The number needed to screen to detect one candidate for endocarditis prophylaxis was 13 (95% confidence interval CI 7 to 44) for patients treated within 10 years and 1.6 (95% CI 1.3 to 1.9) for those treated at least 20 years ago. Compared with the Framingham Heart Study population, mildly reduced left ventricular fractional shortening (<30%) was more common (36% vs. 3%), and age- and gender-adjusted left ventricular mass was lower (90 +/- 27 g/m vs. 117 g/m) in irradiated patients. CONCLUSIONS: There is a high prevalence of asymptomatic heart disease in general, and aortic valvular disease in particular, following mediastinal irradiation. Screening echocardiography should be considered for patients with a history of mediastinal irradiation.

Bookmark