Prevention, Diagnosis, and Management of Radiation-Associated Cardiac Disease

• Published in: Journal of the American College of Cardiology 2019-08, Vol.74 (7), p.905-927
• Main Authors: Desai, Milind Y., Windecker, Stephan, Lancellotti, Patrizio, Bax, Jeroen J., Griffin, Brian P., Cahlon, Oren, Johnston, Douglas R.
• Format: Article
• Language: English
• Subjects: cardiac disease; diagnosis; management; radiation; review
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2019.07.006

Radiation-associated cardiac disease, a heterogeneous and complex disease, manifests years or even decades following radiation exposure to the chest. It is associated with a significantly higher morbidity and mortality. Often, the presentation is vague and overlaps with many diseases, presenting unique diagnostic and management issues. As a result, a high index of suspicion followed by multimodality imaging is crucial, along with comprehensive screening to enable early detection. Timing of intervention should be carefully considered in these patients, because surgery is often complex with an emerging role of percutaneous interventions. [Display omitted] •RACD, a heterogeneous disease that can manifest years or decades following radiation exposure to the chest, is associated with high morbidity and mortality•It is crucial to develop comprehensive multimodality imaging-based screening protocols to adequately identify those at risk, plan interventions, and evaluate treatment responses.•Coordinated management by an experienced team of providers at a center of excellence is strongly advocated with individualized timing of surgery or percutaneous interventions.•The longer-term goal should involve developing radiotherapy protocols that minimize the chances of developing RACD.