Long-term outcome and medical radiation exposure in patients hospitalized for cardiovascular disease

Carpeggiani, Clara; Rossi, Giuseppe; Landi, Patrizia; Michelassi, Claudio; Brambilla, Marco; Cortigiani, Lauro

doi:10.1016/j.ijcard.2015.05.080

Cited by 19 publications

(14 citation statements)

References 40 publications

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“…Consistent with the stochastic mechanism of the radiation related injury, previous observational studies reported increased malignancy rates for both patients undergoing electrophysiological procedures and EP lab staff, with a higher biological harm in the pediatric population . For that reason, emerging zero‐fluoroscopy EP procedures (including AVNRT ablation) using 3‐D EAMs have been increasingly introduced in the EP labs .…”

Section: Discussionsupporting

confidence: 59%

Zero‐fluoroscopy cryothermal ablation of atrioventricular nodal re‐entry tachycardia guided by endovascular and endocardial catheter visualization using intracardiac echocardiography (Ice&ICE Trial)

Luani

Zrenner

Basho³

et al. 2017

Cardiovasc electrophysiol

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Section: Discussionsupporting

confidence: 59%

Zero‐fluoroscopy cryothermal ablation of atrioventricular nodal re‐entry tachycardia guided by endovascular and endocardial catheter visualization using intracardiac echocardiography (Ice&ICE Trial)

Luani

Zrenner

Basho³

et al. 2017

Cardiovasc electrophysiol

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“…24 For men and women aged at least 60 years at the time of the first PCI, excess risk of potentially fatal cancers attributable to radiation ranged from 0.4% to 4%. 26,27 The number of PCIs is a risk factor for subsequent development of lung cancer 28 and leukemia, 23 and contributes to the majority of the significant radiological exposure of the adult cardiology patient. 29 In a previous study in a much larger population of 16 311 inhospital cardiac patients admitted to our institution over the past 40 years, we showed that the cumulative estimated effective radiation dose from cardiologic testing was a significant predictor of cancer death and for (fatal and nonfatal) cancer onset.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

“…29 In a previous study in a much larger population of 16 311 inhospital cardiac patients admitted to our institution over the past 40 years, we showed that the cumulative estimated effective radiation dose from cardiologic testing was a significant predictor of cancer death and for (fatal and nonfatal) cancer onset. 28…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

Stress Echocardiography Positivity Predicts Cancer Death

Carpeggiani

Landi

Michelassi

et al. 2017

JAHA

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BackgroundStress echocardiography (SE) predicts cardiac death, but an increasing share of cardiac patients eventually die of cancer. The aim of the study was to assess whether SE positivity predicts cancer death.Methods and ResultsIn a retrospective analysis of prospectively acquired single‐center, observational data, we evaluated 4673 consecutive patients who underwent SE from 1983 to 2009. All patients were cancer‐free at index SE and were followed up for a median of 131 months (interquartile range 134). We separately analyzed predetermined end points: cardiovascular, cancer, and noncardiovascular, noncancer death, with and without competing risk. SE was positive in 1757 and negative in 2916 patients; 869 cardiovascular, 418 cancer, and 625 noncardiovascular, noncancer deaths were registered. The 25‐year mortality was higher in SE‐positive than in SE‐negative patients, considering cardiovascular (40% versus 31%; P<0.001) and cancer mortality (26% versus 17%; P<0.01). SE positivity was a strong predictor of cancer (cause‐specific hazard ratio 1.19; 95% confidence interval, 1.16–1.73; P=0.05) and cardiovascular mortality (1.18; 95% confidence interval, 1.03–1.35; P=0.02). Fine–Gray analysis to account for competing risk gave similar results. Cancer risk diverged after 15 years, whereas differences were already significant at 5 years for cardiovascular risk.Conclusions SE results predict cardiovascular and cancer mortality. SE may act as a proxy of the shared risk factor milieu for cancer or cardiovascular death.

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“…percutaneous coronary intervention, arrhythmia ablation) can result in exposure to a significant amount of radiation. In fact, data from large sample size observational studies reported an increased malignancy rate, over a long term follow up, both for patients undergoing radiological examinations than electrophysiological procedures 3 . An intervention such as atrial fibrillation ablation, for example, exposes patients to a dose of around 15 mSv (ranging from 1-60 mSv), increasing the absolute lifetime risk of a fatal cancer in an adult by about 0.08% (considered on a background fatal cancer risk of about 20%) 4 , 5 and this biological harm is obviously even higher within the paediatric population.…”

Section: Biological Effects Of Radiation and Evidence Of Harmmentioning

confidence: 99%

The dream of near-zero X-rays ablation comes true

et al. 2016

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Abstract:While radiation exposure related to natural sources plays a minor role, medicine-related exposure, represents, to date, a major exposure source. Within this exposure interventional electrophysiology is a relevant contributor. Unfortunately no safe dose in radioprotection exists, the negative acute and long term effects of radiological exposure may emerge at any radiation exposure dose. For this reason patients and physicians should be aware of the risk of radiation exposure and the benefits of the imaging/procedure balanced by the required radiation exposure. Given this, performing a near to zero x-rays transcatheter ablation procedure should therefore represent an aim for all electrophysiological lab. Fortunately, the introduction of electroanatomic mapping systems, have provided the possibility to perform simple and complex electrophysiological procedures avoiding, or at least, limiting the use of radiations. The present review summarizes state of the art of feasibility and safety of the near to zero approach for the main electrophysiological procedures, highlighting the potential health benefits.3

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Long-term outcome and medical radiation exposure in patients hospitalized for cardiovascular disease

Cited by 19 publications

References 40 publications

Zero‐fluoroscopy cryothermal ablation of atrioventricular nodal re‐entry tachycardia guided by endovascular and endocardial catheter visualization using intracardiac echocardiography (Ice&ICE Trial)

Zero‐fluoroscopy cryothermal ablation of atrioventricular nodal re‐entry tachycardia guided by endovascular and endocardial catheter visualization using intracardiac echocardiography (Ice&ICE Trial)

Stress Echocardiography Positivity Predicts Cancer Death

The dream of near-zero X-rays ablation comes true

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