Cardiovascular Complications Associated with Mediastinal Radiation

Abstract

Purpose of review: Radiation-induced heart disease (RIHD) encompasses a broad range of pathologies and is a significant source of morbidity and mortality among cancer survivors. Increased awareness of the early and late consequences of mediastinal radiation has led to the development of strategies for cardiac risk reduction to improve outcomes through active surveillance and early detection of RIHD. This review aims to discuss the current knowledge on the presentation, diagnosis, and management of RIHD.

Recent findings: Decades' worth of cohort data demonstrates an increased risk of RIHD as cancer survivors age. Additionally, interventional/surgical management of irradiated patients poses unique considerations and can be technically challenging. Used in conjunction with echocardiography, multimodality imaging for morphologic and functional assessment adds complementary value in screening, surveillance, and targeted symptom investigation in patients at risk for RIHD. Furthermore, sensitive imaging parameters and biomarkers have shown potential in detecting subclinical RIHD. Despite the development of techniques which minimize cardiac exposure to ionizing radiation, their effects on the long-term development of RIHD remain to be seen. Due to the morbidity and mortality associated with RIHD, both patients and clinicians should be aware of the lifelong cardiovascular risks of mediastinal radiation exposure. RIHD surveillance should be a consideration throughout the survivorship period. Studies to evaluate the clinical consequences of contemporary radiation therapy strategies aimed at minimizing cardiac doses and the value of novel, more sensitive metrics for the early detection or prognostication of RIHD are ongoing.

Keywords: Cardio-oncology; Cardiotoxicity; Heart disease; Radiation; Radiation therapy; Survivorship.