Radiation-induced coronary artery disease

Abstract

Radiation-induced heart disease must be considered in any patient with cardiac symptomatology who had prior mediastinal irradiation. Radiation can affect all the structures in the heart, including the pericardium, the myocardium, the valves and the conduction system. In addition to these pathologies, coronary artery disease following mediastinal radiotherapy is the most actual cardiac pathology as it may cause cardiac emergencies requiring interventional cardiological or surgical interventions. Case A 36-year-old man was admitted to the clinic with unstable angina pectoris of one month duration. The patient had no coronary artery disease risk factor. The history of the patient revealed that he had mediastinal radiotherapy due to Hodgkin's disease at 10-year of age. Coronary arteriography showed total occlusion of the left anterior descending artery and 70% stenosis of the proximal right coronary artery. Both arteries are dilated with placement of two stents. Control coronary arteriography at the end of the first year showed patency of both stents and the patient is free of symptoms. Previous radiotherapy to the mediastinum should be considered as a risk factor for the development of premature coronary artery disease. Percutaneous transluminal coronary angioplasty with stent placement or surgical revascularization are the preferred methods of treatment. Preoperative assessment of internal thoracic arteries should be considered prior to surgery. As the radiation therapy is currently the standard treatment for a number of mediastinal malignancies, routine screening of these patients and optimal cardiac prevention during radiotherapy are the only ways to minimize the incidence of radiation-induced heart disease.

Unstable angina in a young woman with Hodgkin’s lymphoma

“…This becomes an important clinical problem as approximately 50% of HL patients may require RT [5]. The manifestations include not only CAD but also arrhythmia, acute pericarditis, pericardial effusion with or without cardiac tamponade, and constructive pericarditis [6].…”

“…It provokes smooth muscle cells proliferation, collagen intimal and medial deposits, and an increase in the number of plasma cells with the presence of large fibroblasts [11,12]. This is the opposite of typical atherosclerotic plaques that are more abundant in lipids and lymphocytes [6] and with a higher risk of rupture. On the other hand, in vitro studies have revealed the prothrombotic effect of radiation connected with higher release of von Willebrand factor that can provoke coronary thrombosis [13].…”

Circulating progenitor cells contribute to neointimal formation in nonirradiated chimeric mice

“…All data are presented as mean Ϯ se. damage (29), carotid artery stenosis (31), and coronary artery disease (32)(33)(34)(35). Irradiation also affects viability and proliferation of host cells (36).…”

Radiation Therapy Induced Cardiovascular Disease

“…Prior to the development of contemporary drug eluting stents, lesions treated with balloon angioplasty demonstrated progressive disease and restenosis (56,59). There is very limited data relating to the use of stents to treat radiation-induced coronary disease (60)(61) and almost no data on therapy for left main disease, which is commonly seen in radiation-induced coronary artery disease. Early data with bare metal stents (BMS) suggested high rates of restenosis, particularly in patients with impaired ejection fraction or small left main coronary arteries (62).…”