Author + information
- Received May 3, 2019
- Revision received June 28, 2019
- Accepted July 7, 2019
- Published online August 12, 2019.
- Milind Y. Desai, MDa,∗ (, )@DesaiMilindY,
- Stephan Windecker, MD, PhDb,
- Patrizio Lancellotti, MD, PhDc,
- Jeroen J. Bax, MD, PhDd,
- Brian P. Griffin, MDa,
- Oren Cahlon, MDe and
- Douglas R. Johnston, MDf
- aDepartment of Cardiovascular Medicine, Center for Radiation Heart Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- bDepartment of Cardiology, Inselspital, University of Bern, Bern, Switzerland
- cDepartment of Cardiology, University of Leige Hospital, CHU Sart Tilman, Liege, Belgium
- dDepartment of Cardiology, University of Leiden, the Netherlands
- eDepartment of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
- fDepartment of Cardiothoracic Surgery, Center for Radiation Heart Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
- ↵∗Address for correspondence:
Dr. Milind Y. Desai, Department of Cardiovascular Medicine, Desk J1-5, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio 44195.
• 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.
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.
Dr. Desai has received support from the Haslam Family endowed chair in cardiovascular medicine and the Khouri family philanthropic support for research in premature coronary artery disease. Dr. Windecker has received research, educational, and travel grants to his institution from Amgen, Abbott, Bristol-Myers Squibb, Bayer, Boston Scientific, Biotronik, CSL Behring, Medtronic, Edwards Lifesciences, Sinomed, and Polares. Dr. Johnston has been a consultant for Abbott; has served on a steering committee for the ProactXa trial; and has received educational honoraria from Edwards Lifesciences and LivaNova. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received May 3, 2019.
- Revision received June 28, 2019.
- Accepted July 7, 2019.
- 2019 American College of Cardiology Foundation
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