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Yasmin F, Moeed A, Alam MT, Virwani V, Khabir Y, Shaikh A, Vyas AV, Alraies MC. Outcomes after transcatheter aortic valve replacement in cancer survivors with prior chest radiation therapy: an updated systematic review and meta-analysis. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2024; 10:61. [PMID: 39267144 PMCID: PMC11391771 DOI: 10.1186/s40959-024-00265-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Accepted: 09/05/2024] [Indexed: 09/14/2024]
Abstract
Clinical outcomes for TAVR in cancer survivors with prior chest radiation therapy (C-XRT) who develop symptomatic aortic-valve stenosis are not adequately assessed in major clinical trials leading to conflicting results. Hence, we conducted this meta-analysis to evaluate the, safety, efficacy, and mortality outcomes of cancer survivors with prior C-XRT undergoing TAVR. MEDLINE and Scopus were searched up to March 2024. Observational studies and randomized controlled trials comparing severe aortic stenosis patients with and without prior C-XRT undergoing TAVR with at least one outcome of interest were shortlisted. Data were analyzed using random-effects model to derive weighted mean differences, and risk ratios with 95% confidence intervals. Six studies with 6,191 patients (278 C-XRT and 5,913 no-C-XRT) were included. All-cause mortality at 30-day (RR 1.63, p = 0.12) and 1-year interval (RR 1.59, p = 0.08) showed no significant differences with prior C-XRT versus no-C-XRT. Worsening CHF was the only post-procedural safety outcome significantly higher in patients with prior C-XRT (RR 1.98, p = 0.0004) versus no- C-XRT. The efficacy end-points i.e., improvement in LVEF (MD 1.24; -0.50, 2.98), and aortic valve gradient (MD -0.63; -1.32, 0.05) were not significantly different. TAVR has similar all-cause mortality, efficacy and safety (except CHF worsening) among cancer survivors with and without a prior history of C-XRT.
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Affiliation(s)
- Farah Yasmin
- Yale University School of Medicine, New Haven, CT, 06511, USA.
- Yale School of Medicine, New Haven, CT, 06511, USA.
| | - Abdul Moeed
- Dow University of Health Sciences, Karachi, PK, Pakistan
| | | | | | - Yumna Khabir
- Dow University of Health Sciences, Karachi, PK, Pakistan
| | - Asim Shaikh
- Aga Khan University Hospital, Karachi, 74800, Pakistan
| | - Apurva V Vyas
- Lehigh Valley Heart and Vascular Institute, Allentown, PA, USA
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2
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Gajjar R, Carlini GB, Teaima T, Aziz I, Vardar U, Jamshed A, Karki S, Dhar G, Jolly N, Vij A. Outcomes of transcatheter aortic valve replacement in patients with history of chest wall irradiation: Propensity matched analysis of five years data from national inpatient sample (2016-2020). CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024:S1553-8389(24)00508-6. [PMID: 38806330 DOI: 10.1016/j.carrev.2024.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/06/2024] [Accepted: 05/22/2024] [Indexed: 05/30/2024]
Abstract
INTRODUCTION Chest radiotherapy has been utilized to treat intra-thoracic and mediastinal tumors. Chest wall irradiation (C-XRT) survivors frequently develop valvular disease, including aortic stenosis, which eventually requires valve replacement. Previous trials have shown worse outcomes with surgical aortic valve replacement. However, transcatheter aortic valve replacement (TAVR) outcomes-related data in patients with C-XRT is limited. METHODS The national inpatient sample (NIS) database was queried from 2016 to 2020 to identify adult hospitalizations with TAVR, which were dichotomized based on a history of C-XRT using ICD-10-CM codes. Propensity score matching was performed to derive age, sex, hospital characteristics, and co-morbidities matched controls without a history of C-XRT. The outcomes studied were inpatient mortality and complications, mean length of stay (LOS), and total hospital charge (THC). Multivariate logistic and linear regression were used to analyze the outcomes. RESULTS Of 296,670 patients who underwent TAVR between 2016 and 2020, 515 had a history of C-XRT. Upon propensity score matching in patients undergoing TAVR, Patients with a history of C-XRT showed significantly lower adjusted odds of in-hospital mortality (adjusted odd ratio [aOR] 0.04, 95 % CI [0.003-0.57], p = 0.017), lower mean LOS by 1.6 days (-1.88 to -1.26 days, p < 0.001) and reduced mean THC (-$74,720, [-$88,784 to -$60,655], p < 0.001). Additionally, patients with C-XRT had significantly lower adjusted odds of inpatient complications, mainly acute myocardial infarction, cerebrovascular events, acute respiratory failure, acute kidney injury, need for vasopressors and cardiopulmonary resuscitation, whereas similar odds of complications, including a requirement of intubation, mechanical ventilation, hemodialysis, and cardiogenic shock. CONCLUSION Our analysis showed reduced adjusted odds of in-hospital mortality, length of stay, total hospital charges, and inpatient complications in patients undergoing TAVR with a history of C-XRT. TAVR appears to be a safe and viable alternative in this population subgroup.
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Affiliation(s)
- Rohan Gajjar
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA.
| | | | - Taha Teaima
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Imran Aziz
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Ufuk Vardar
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Aneeza Jamshed
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Sadichhya Karki
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Gaurav Dhar
- Rush University Medical Center, Chicago, IL, USA
| | - Neeraj Jolly
- Rush University Medical Center, Chicago, IL, USA
| | - Aviral Vij
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA; Rush University Medical Center, Chicago, IL, USA
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3
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Leedy D, Elison DM, Farias F, Cheng R, McCabe JM. Transcatheter aortic valve intervention in patients with cancer. Heart 2023; 109:1508-1515. [PMID: 37147132 DOI: 10.1136/heartjnl-2022-321396] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/16/2023] [Indexed: 05/07/2023] Open
Abstract
The prevalence of concurrent cancer and severe aortic stenosis (AS) is increasing due to an ageing population. In addition to shared traditional risk factors for AS and cancer, patients with cancer may be at increased risk for AS due to off-target effects of cancer-related therapy, such as mediastinal radiation therapy (XRT), as well as shared non-traditional pathophysiological mechanisms. Compared with surgical aortic valve replacement, major adverse events are generally lower in patients with cancer undergoing transcatheter aortic valve intervention (TAVI), especially in those with history of mediastinal XRT. Similar procedural and short-to-intermediate TAVI outcomes have been observed in patients with cancer as compared with no cancer, whereas long-term outcomes are dependent on cancer survival. Considerable heterogeneity exists between cancer subtypes and stage, with worse outcomes observed in those with active and advanced-stage disease as well as specific cancer subtypes. Procedural management in patients with cancer poses unique challenges and thus requires periprocedural expertise and close collaboration with the referring oncology team. The decision to ultimately pursue TAVI involves a multidisciplinary and holistic approach in assessing the appropriateness of intervention. Further clinical trial and registry studies are needed to better appreciate outcomes in this population.
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Affiliation(s)
- Douglas Leedy
- Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - David M Elison
- Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - Francisco Farias
- Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Richard Cheng
- Cardiology, University of Washington Medical Center, Seattle, Washington, USA
| | - James M McCabe
- Cardiology, University of Washington Medical Center, Seattle, Washington, USA
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Valvular Heart Disease Associated With Radiation Therapy: A Contemporary Review. STRUCTURAL HEART 2023. [DOI: 10.1016/j.shj.2022.100104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
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5
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Belzile-Dugas E, Fremes SE, Eisenberg MJ. Radiation-Induced Aortic Stenosis: An Update on Treatment Modalities. JACC. ADVANCES 2023; 2:100163. [PMID: 38939030 PMCID: PMC11198354 DOI: 10.1016/j.jacadv.2022.100163] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/14/2022] [Accepted: 11/16/2022] [Indexed: 06/29/2024]
Abstract
The adverse effects of radiation therapy for cancer are well described and can include a wide array of cardiac complications. Radiation-induced aortic stenosis (AS) is an increasingly recognized entity that poses particular therapeutic challenges. Several retrospective studies comparing the outcomes after transcatheter aortic valve replacement (TAVR) vs those after surgical aortic valve replacement patients with radiation-induced AS have found a trend toward decreased mortality and fewer major complications with TAVR. Surgical aortic valve replacement is associated with increased mortality in patients with radiation-induced AS compared with patients without a history of prior radiation. TAVR has been shown to be a safe and effective alternative in patients with radiation-induced AS, with safety similar to that for patients who have not received prior radiation. However, rare and unexpected complications may occur after TAVR from the deleterious effects of radiation on mediastinal structures. More studies are needed to identify the optimal way of managing patients with radiation-induced AS, and algorithms are needed for planning these complex interventions.
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Affiliation(s)
- Eve Belzile-Dugas
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Québec, Canada
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Stephen E. Fremes
- Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Mark J. Eisenberg
- Division of Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital/McGill University, Montreal, Québec, Canada
- Department of Medicine, McGill University, Montreal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
- Division of Cardiology, Jewish General Hospital/McGill University, Montreal, Québec, Canada
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Schwarzman LS, Megowan N, Manubolu VS, Shah SU. A Rare Case of Radiation-Associated Aortic and Mitral Valve Stenosis Treated With Transcatheter Valve Replacements. JACC Case Rep 2022; 8:101672. [PMID: 36860564 PMCID: PMC9969551 DOI: 10.1016/j.jaccas.2022.08.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/23/2022] [Accepted: 08/30/2022] [Indexed: 11/06/2022]
Abstract
Radiation therapy is the standard of care for achieving cure for many thoracic malignancies, but it can result in long-term cardiovascular sequelae such as valve disease. We describe a rare case of severe aortic and mitral stenosis due to prior radiation therapy for giant cell tumor treated successfully with percutaneous aortic and off-label mitral valve replacements. (Level of Difficulty: Intermediate.).
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Affiliation(s)
- Logan S. Schwarzman
- Division of Cardiology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Nichelle Megowan
- Division of Cardiology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, California, USA
| | | | - Sonia U. Shah
- Division of Cardiology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, California, USA,The Lundquist Institute, Torrance, California, USA,Address for correspondence: Dr Sonia U. Shah, Harbor-UCLA Medical Center, 1124 West Carson Street, RB2 #405, Torrance, California 90502, USA.
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7
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Mohanty BD, Coylewright M, Sequeira AR, Shin D, Liu Y, Li D, Fradley M, Alu MC, Mack MJ, Kapadia SR, Kodali S, Thourani VH, Makkar RR, Leon MB, Malenka D. Characteristics and clinical outcomes in patients with prior chest radiation undergoing TAVR: Observations from PARTNER-2. Catheter Cardiovasc Interv 2022; 99:1877-1885. [PMID: 35289473 DOI: 10.1002/ccd.30154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/25/2022] [Accepted: 02/21/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES The purpose of this study is to investigate the viability of transcatheter aortic valve replacement (TAVR) for severe symptomatic aortic stenosis (AS) in patients with prior chest radiation therapy (cXRT). BACKGROUND Since patients with prior cXRT perform poorly with surgical aortic valve replacement, TAVR can be a viable alternative. However, clinical outcomes after TAVR in this patient population have not been well studied. METHODS From the pooled registry of the placement of aortic transcatheter valves II trial, we identified patients with and without prior cXRT who underwent TAVR (n = 64 and 3923, respectively). The primary outcome was a composite of all-cause death and any stroke at 2 years. Time to event analyses were shown as Kaplan-Meier event rates and compared by log-rank testing. Hazard ratios (HRs) were estimated and compared by Cox proportional hazards regression model. RESULTS There was no significant difference in the primary outcome between the patients with and without prior cXRT (30.7% vs. 27.0%; p = 0.75; HR, 1.08; 95% confidence interval, 0.66-1.77). Rates of myocardial infarction, vascular complications, acute kidney injury, or new pacemaker implant after TAVR were not statistically different between the two groups. The rate of immediate reintervention with a second valve for aortic regurgitation after TAVR was higher among the patients with prior cXRT. However, no further difference was observed during 2 years follow-up after discharge from the index-procedure hospitalization. CONCLUSIONS TAVR is a viable alternative for severe symptomatic AS in patients who had cXRT in the past.
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Affiliation(s)
- Bibhu D Mohanty
- Department of Cardiovascular Sciences, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Megan Coylewright
- Department of Cardiology, Erlanger Health System, Chattanooga, Tennessee, USA
| | - Ashton R Sequeira
- Department of Internal Medicine,Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| | - Doosup Shin
- Division of Cardiovascular Diseases, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Yangbo Liu
- Cardiovascular Research Foundation, New York City, New York, USA
| | - Ditian Li
- Cardiovascular Research Foundation, New York City, New York, USA
| | - Michael Fradley
- Cardio-Oncology Program, Division of Cardiovascular Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maria C Alu
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York City, New York, USA
| | - Michael J Mack
- Cardiothoracic Surgery Service, Baylor Scott & White Healthcare, Plano, Texas, USA
| | - Samir R Kapadia
- Department of Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Susheel Kodali
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York City, New York, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Raj R Makkar
- Interventional Cardiology Division, Los Angeles, California, USA
| | - Martin B Leon
- Structural Heart and Valve Center, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York City, New York, USA
| | - David Malenka
- Division of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Abstract
Radiation therapy demonstrates a clear survival benefit in the treatment of several malignancies. However, cancer survivors can develop a wide array of cardiotoxic complications related to radiation. This pathology is often underrecognized by clinicians and there is little known on how to manage this population. Radiation causes fibrosis of all components of the heart and significantly increases the risk of coronary artery disease, cardiomyopathy, valvulopathy, arrhythmias, and pericardial disease. Physicians should treat other cardiovascular risk factors aggressively in this population and guidelines suggest obtaining regular imaging once symptomatology is established. Patients with radiation‐induced cardiovascular disease tend to do worse than their traditional counterparts for the same interventions. However, there is a trend toward fewer complications and lower mortality with catheter‐based rather than surgical approaches, likely because radiation makes these patients poor surgical candidates. When appropriate, these patients should be referred for percutaneous management of valvulopathy and coronary disease.
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Affiliation(s)
- Eve Belzile-Dugas
- Division of Clinical Epidemiology Lady Davis InstituteJewish General HospitalMcGill University Montreal QC Canada.,Department of Medicine McGill University Montreal QC Canada
| | - Mark J Eisenberg
- Division of Clinical Epidemiology Lady Davis InstituteJewish General HospitalMcGill University Montreal QC Canada.,Department of Medicine McGill University Montreal QC Canada.,Department of Epidemiology, Biostatistics and Occupational Health McGill University Montreal QC Canada.,Division of Cardiology Jewish General HospitalMcGill University Montreal QC Canada
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9
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Rosmini S, Aggarwal A, Chen DH, Conibear J, Davies CL, Dey AK, Edwards P, Guha A, Ghosh AK. Cardiac computed tomography in cardio-oncology: an update on recent clinical applications. Eur Heart J Cardiovasc Imaging 2021; 22:397-405. [PMID: 33555007 DOI: 10.1093/ehjci/jeaa351] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 12/08/2020] [Indexed: 01/07/2023] Open
Abstract
Chemotherapy and radiotherapy have drastically improved cancer survival, but they can result in significant short- and long-term cardiovascular complications, most commonly heart failure from chemotherapy, whilst radiotherapy increases the risk of premature coronary artery disease (CAD), valve, and pericardial diseases. Cardiac computed tomography (CT) with calcium scoring has a role in screening asymptomatic patients for premature CAD, cardiac CT angiography (CTCA) allows the identification of significant CAD, also in the acute settings where concerns exist towards invasive angiography. CTCA integrates the diagnostic work-up and guides surgical/percutaneous management of valvular heart diseases and allows the assessment of pericardial conditions, including detection of effusion and pericardial calcification. It is a widely available and fast imaging modality that allows a one-step evaluation of CAD, myocardial, valvular, and pericardial disease. This review aims to provide an update on its current use and accompanying evidence-base for cardiac CT in the management of cardio-oncology patients.
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Affiliation(s)
- Stefania Rosmini
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London EC1A 7BE, UK
| | - Ankita Aggarwal
- Department of Internal Medicine, Wayne State University, Providence Hospital, Rochester, MI, USA
| | - Daniel H Chen
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London EC1A 7BE, UK.,Cardio-Oncology Service, University College London Hospital, London, UK.,Hatter Cardiovascular Institute, University College London, London, UK
| | - John Conibear
- Oncology Department, Barts Cancer Centre, St Bartholomew's Hospital London, UK
| | - Ceri L Davies
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London EC1A 7BE, UK
| | - Amit Kumar Dey
- National Heart, Lung and Blood Institute, Bethesda, USA.,Department of Internal Medicine, Georgetown University, Washington, DC, USA
| | - Paula Edwards
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Avirup Guha
- Harrington Heart and Vascular Institute, Cleveland, 11100 Euclid Ave, Cleveland, OH 44106, USA
| | - Arjun K Ghosh
- Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, London EC1A 7BE, UK.,Cardio-Oncology Service, University College London Hospital, London, UK.,Hatter Cardiovascular Institute, University College London, London, UK
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10
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Obayashi Y, Sakamoto J, Hamaguchi Y, Hamasaki M, Mima H, Kojima H, Yamasaki S, Okamoto H, Tamura A, Kuroda M, Harita T, Nishiuchi S, Tamaki Y, Enomoto S, Miyake M, Kondo H, Sakaguchi H, Iwakura A, Tamura T. Successful Transcatheter Aortic Valve Implantation in a Patient with Radiation-induced Aortic Stenosis for Mediastinal Hodgkin Lymphoma. Intern Med 2021; 60:1043-1046. [PMID: 33116008 PMCID: PMC8079924 DOI: 10.2169/internalmedicine.5310-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Aortic stenosis (AS), a late complication of thoracic radiation therapy for chest lesions, is often coincident with porcelain aorta or hostile thorax. We herein report a 59-year-old man with a history of mediastinal Hodgkin lymphoma treated with radiation therapy but later presenting with heart failure caused by severe AS. Severe calcification in the mediastinum and around the ascending aorta made it difficult to perform surgical aortic valve replacement. The patient therefore underwent transcatheter aortic valve implantation (TAVI). It is important to recognize radiation-induced AS early, now that TAVI is a well-established treatment required by increasing numbers of successfully treated cancer patients.
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Affiliation(s)
| | | | | | | | - Hibiki Mima
- Department of Cardiology, Tenri Hospital, Japan
| | | | | | | | | | | | | | | | - Yodo Tamaki
- Department of Cardiology, Tenri Hospital, Japan
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11
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Yang EH, Marmagkiolis K, Balanescu DV, Hakeem A, Donisan T, Finch W, Virmani R, Herrman J, Cilingiroglu M, Grines CL, Toutouzas K, Iliescu C. Radiation-Induced Vascular Disease-A State-of-the-Art Review. Front Cardiovasc Med 2021; 8:652761. [PMID: 33860001 PMCID: PMC8042773 DOI: 10.3389/fcvm.2021.652761] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/05/2021] [Indexed: 12/14/2022] Open
Abstract
Since the 1990s, there has been a steady increase in the number of cancer survivors to an estimated 17 million in 2019 in the US alone. Radiation therapy today is applied to a variety of malignancies and over 50% of cancer patients. The effects of ionizing radiation on cardiac structure and function, so-called radiation-induced heart disease (RIHD), have been extensively studied. We review the available published data on the mechanisms and manifestations of RIHD, with a focus on vascular disease, as well as proposed strategies for its prevention, screening, diagnosis, and management.
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Affiliation(s)
- Eric H Yang
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Dinu V Balanescu
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, United States
| | - Abdul Hakeem
- Division of Cardiovascular Diseases & Hypertension, Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Teodora Donisan
- Department of Internal Medicine, Beaumont Hospital, Royal Oak, MI, United States
| | - William Finch
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Renu Virmani
- CVPath Institute, Gaithersburg, MD, United States
| | - Joerg Herrman
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, United States
| | - Mehmet Cilingiroglu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States.,University of Hawaii John Burns School of Medicine, Honolulu, HI, United States
| | - Cindy L Grines
- Cardiovascular Institute, Northside Hospital, Atlanta, GA, United States
| | | | - Cezar Iliescu
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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12
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Structural Transcatheter Cardiac Interventions in the Cardio-Oncology Population. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00898-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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13
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Murphy AC, Koshy AN, Cameron W, Horrigan M, Kearney L, Yeo B, Farouque O, Yudi MB. Transcatheter aortic valve replacement in patients with a history of cancer: Periprocedural and long-term outcomes. Catheter Cardiovasc Interv 2021; 97:157-164. [PMID: 32497385 DOI: 10.1002/ccd.28969] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/15/2020] [Accepted: 05/04/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND A history of cancer is incorporated into the surgical risk assessment of patients undergoing surgical aortic valve replacement through the Society for Thoracic Surgeons score. However, the prognostic significance of cancer in patients treated with transcatheter aortic valve replacement (TAVR) is unclear. As the cancer survivorship population increases, it is imperative to establish the efficacy and safety of TAVR in patients with severe symptomatic aortic stenosis (AS) and a history of malignancy. OBJECTIVES The primary goal of this study was to assess the periprocedural outcomes and long-term mortality in patients with a history of cancer undergoing TAVR. METHODS A systematic review of PubMed, MEDLINE, and EMBASE was conducted to identify studies reporting outcomes in patients with a history of malignancy undergoing TAVR. A meta-analysis was performed using a random-effects model with a primary outcome of all-cause mortality and cardiac mortality at the longest follow-up. On secondary analyses, procedural safety was assessed. RESULTS A total of 13 observational studies with 10,916 patients were identified in the systematic review. Seven studies including 6,323 patients were included in the quantitative analysis. Short-term mortality (relative risk [RR] 0.61, 95%CI 0.36-1.01; p = .06) and long-term all-cause mortality (RR 1.24, 95%CI 0.95-1.63; p = .11) were not significantly different when comparing patients with and without a history of cancer. No significant difference in the rate of periprocedural complications including stroke, bleeding, acute kidney injury, and pacemaker implantation was noted. CONCLUSION In patients with severe AS undergoing TAVR, a history of cancer was not associated with adverse short or long-term survival. Based on these findings, TAVR should be considered in all patients with severe symptomatic AS, irrespective of their history of malignancy.
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Affiliation(s)
- Alexandra C Murphy
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anoop N Koshy
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - William Cameron
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Mark Horrigan
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia
| | - Leighton Kearney
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Belinda Yeo
- Department of Oncology, The Olivia Newton-John Cancer and Wellness Centre, Melbourne, Victoria, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Matias B Yudi
- Department of Cardiology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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Kherallah RY, Harrison D, Preventza O, Silva GV, Dougherty KG, Coulter SA, Simpson L, Strickman NE, Mortazavi A, Palaskas N, Fish RD, Krajcer Z, Stainback RF, Gomez JCP, Livesay JJ, Coselli JS, Koneru S. Transcatheter aortic valve replacement after chest radiation: A propensity-matched analysis. Int J Cardiol 2020; 329:50-55. [PMID: 33359282 DOI: 10.1016/j.ijcard.2020.12.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/06/2020] [Accepted: 12/11/2020] [Indexed: 01/26/2023]
Abstract
BACKGROUND Chest radiation therapy (CRT) for malignant thoracic neoplasms is associated with development of valvular heart disease years later. As previous radiation exposure can complicate surgical treatment, transcatheter aortic valve replacement (TAVR) has emerged as an alternative. However, outcomes data are lacking for TAVR patients with a history of CRT. METHODS We conducted a retrospective study of all patients who underwent a TAVR procedure at a single institution between September 2012 and November 2018. Among 1341 total patients, 50 had previous CRT. These were propensity-matched in a 1:2 ratio to 100 patients without history of CRT. Thirty-day adverse events were analyzed with generalized estimating equation models. Overall mortality was analyzed with stratified Cox regression modelling. RESULTS Median clinical follow-up was 24 months (interquartile range [IQR], 12-44 months). There was no difference between CRT and non-CRT patients in overall mortality (hazard ratio [HR] 0.84 [0.37-1.90], P = 0.67), 30-day mortality (HR 3.1 [0.49-20.03], P = 0.23), or 30-day readmission rate (HR 1.0 [0.43-2.31], P = 1). There were no differences in the rates of most adverse events, but patients with CRT history had higher rates of postprocedural respiratory failure (HR 3.63 [1.32-10.02], P = 0.01) and permanent pacemaker implantation (HR 2.84 [1.15-7.01], P = 0.02). CONCLUSIONS For patients with aortic valve stenosis and previous CRT, TAVR is safe and effective, with outcomes similar to those in the general aortic stenosis population. Patients with history of CRT are more likely to have postprocedural respiratory failure and to require permanent pacemaker implantation.
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Affiliation(s)
- Riyad Y Kherallah
- Division of Internal Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Darren Harrison
- Division of Internal Medicine, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Ourania Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA
| | | | | | | | - Leo Simpson
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Department of Cardiology, Texas Heart Institute, Houston, TX, USA
| | - Neil E Strickman
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA
| | - Ali Mortazavi
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA
| | - Nicolas Palaskas
- Department of Cardiology, Division of Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Richard D Fish
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA
| | - Zvonimir Krajcer
- Department of Cardiology, Texas Heart Institute, Houston, TX, USA
| | | | - Juan Carlos Plana Gomez
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Department of Cardiology, Texas Heart Institute, Houston, TX, USA
| | - James J Livesay
- Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA
| | - Joseph S Coselli
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA
| | - Srikanth Koneru
- Division of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA; Department of Cardiology, Texas Heart Institute, Houston, TX, USA.
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15
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Turgay Yildirim Ö, Özgeyik M, Okay Özgeyik M. Safety of transcatheter aortic valve replacement at malignancy patients. Int J Cardiol 2020; 323:27. [PMID: 33027682 DOI: 10.1016/j.ijcard.2020.09.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/30/2020] [Indexed: 11/17/2022]
Affiliation(s)
| | - Mehmet Özgeyik
- Eskisehir City Hospital, Department of Cardiology, Eskisehir, Turkey
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16
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Zhang D, Guo W, Al-Hijji MA, El Sabbagh A, Lewis BR, Greason K, Sandhu GS, Eleid MF, Holmes DR, Herrmann J. Outcomes of Patients With Severe Symptomatic Aortic Valve Stenosis After Chest Radiation: Transcatheter Versus Surgical Aortic Valve Replacement. J Am Heart Assoc 2020; 8:e012110. [PMID: 31124737 PMCID: PMC6585322 DOI: 10.1161/jaha.119.012110] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Patients with symptomatic severe aortic stenosis and a history of chest radiation therapy represent a complex and challenging cohort. It is unknown how transcatheter aortic valve replacement ( TAVR ) compares with surgical aortic valve replacement in this group of patients, which was the objective of this study. Methods and Results We retrospectively reviewed all patients with severe aortic stenosis who underwent either TAVR or surgical aortic valve replacement at our institution with a history of mediastinal radiation (n=55 per group). End points were echocardiographic and clinical outcomes in-hospital, at 30 days, and at 1 year. Inverse propensity weighting analysis was used to account for intergroup baseline differences. TAVR patients had a higher STS score than surgical aortic valve replacement patients (5.1% [3.2, 7.7] versus 1.6% [0.8, 2.6], P<0.001) and more often ( P<0.01 for all) a history of atrial fibrillation (45.5% versus 12.7%), chronic lung disease (47.3% versus 7.3%), peripheral arterial disease (38.2% versus 7.3%), heart failure (58.2% versus 18.2%), and pacemaker therapy (23.6% versus 1.8%). Postoperative atrial fibrillation was less frequent (1.8% versus 27.3%; P<0.001) and hospital stay was shorter in TAVR patients (4.0 [2.0, 5.0] versus 6.0 [5.0, 8.0] days; P<0.001). The ratio of observed-to-expected 30-day mortality was lower after TAVR as was 30-day mortality in inverse propensity weighting-adjusted Kaplan-Meier analyses. Conclusions In patients with severe aortic stenosis and a history of chest radiation therapy, TAVR performs better than predicted along with less adjusted 30-day all-cause mortality, postoperative atrial fibrillation, and shorter hospitalization compared with surgical aortic valve replacement. These data support further studies on the preferred role of TAVR in this unique patient population.
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Affiliation(s)
- Dongfeng Zhang
- 1 Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing China
| | - Wei Guo
- 2 Department of Emergency Medicine Peking University People's Hospital Beijing China.,3 Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | | | | | | | - Kevin Greason
- 3 Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | | | - Mackram F Eleid
- 3 Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | - David R Holmes
- 3 Department of Cardiovascular Diseases Mayo Clinic Rochester MN
| | - Joerg Herrmann
- 3 Department of Cardiovascular Diseases Mayo Clinic Rochester MN
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17
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Zafar MR, Mustafa SF, Miller TW, Alkhawlani T, Sharma UC. Outcomes after transcatheter aortic valve replacement in cancer survivors with prior chest radiation therapy: a systematic review and meta-analysis. CARDIO-ONCOLOGY 2020; 6:8. [PMID: 32685198 PMCID: PMC7359474 DOI: 10.1186/s40959-020-00062-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/02/2020] [Indexed: 12/21/2022]
Abstract
Background Cancer survivors with prior chest radiation therapy (C-XRT) frequently present with aortic stenosis (AS) as the first manifestation of radiation-induced heart disease. They are considered high-risk for surgical valve replacement. Transcatheter aortic valve replacement (TAVR) is as an attractive option for this patient population but the outcomes are not well established in major clinical trials. The authors performed a systemic review and meta-analysis of clinical studies for the outcomes after TAVR in cancer survivors with prior C-XRT. Methods Online databases were searched from inception to April 2020 for studies evaluating the outcomes of TAVR in patients with and without C-XRT. We analyzed the pooled estimates (with their 95% confidence intervals) of the odds ratio (OR) for the all-cause mortality at 30-day and 1-year follow-ups, 4-point safety outcomes (stroke, major bleed, access-related vascular complications and need for a pacemaker), a 2-point efficacy outcome (mean aortic valve gradient and left ventricular ejection fraction) and worsening of congestive heart failure (CHF). Four studies were included following 2054 patients with and without prior C-XRT exposure (164 patients and 1890 patients respectively). Results The C-XRT group had similar 30-day mortality compared to the control group (OR 1.29, 95% CI 0.64 to 2.58, p = 0.48). The 1-year mortality was higher in the C-XRT group (OR 1.97, CI 1.15 to 3.39, p = 0.01). Apart from higher congestive heart failure (CHF) exacerbation in the C-XRT group (OR 2.03, CI 1.36 to 3.04, p = 0.0006), TAVR resulted in similar safety and efficacy outcomes in both groups. Conclusion TAVR in the C-XRT group has similar 30-day mortality, safety, and efficacy outcomes compared to the control group; however, they have higher 1-year mortality and CHF exacerbation. Including an oncologist to the cardiology team who considers cancer stage in the decision-making process and applying additional preoperative scores such as frailty indices may refine the risk assessment for these patients. The quality of analyzed data is modest, warranting randomized trials to assess the true benefits of TAVR in these patients.
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Affiliation(s)
- Meer Rabeel Zafar
- Department of Medicine, Division Cardiology, Jacob's School of Medicine and Biomedical Sciences, 875 Ellicott Street, Suite 7030, Buffalo, New York, 14203 USA
| | | | - Timothy W Miller
- Department of Medicine, Division Cardiology, Jacob's School of Medicine and Biomedical Sciences, 875 Ellicott Street, Suite 7030, Buffalo, New York, 14203 USA
| | - Talal Alkhawlani
- Department of Medicine, Division Cardiology, Jacob's School of Medicine and Biomedical Sciences, 875 Ellicott Street, Suite 7030, Buffalo, New York, 14203 USA
| | - Umesh C Sharma
- Department of Medicine, Division Cardiology, Jacob's School of Medicine and Biomedical Sciences, 875 Ellicott Street, Suite 7030, Buffalo, New York, 14203 USA
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18
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Dolmaci OB, Farag ES, Boekholdt SM, van Boven WJP, Kaya A. Outcomes of cardiac surgery after mediastinal radiation therapy: A single-center experience. J Card Surg 2020; 35:612-619. [PMID: 31971292 PMCID: PMC7079019 DOI: 10.1111/jocs.14427] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Background Mediastinal radiation therapy (MRT) is a widely used therapy for thoracic malignancies. This therapy has the potential to cause cardiovascular injuries, which may require surgery. The primary aim of this study is to identify the perioperative outcomes of cardiac surgery in patients with a history of MRT. Second, potential predictors of mortality and adverse events were identified. Methods A retrospective study was conducted among 59 patients with prior MRT who underwent cardiac surgery between December 2009 and March 2015. Included surgeries consisted of procedures through median‐ and ministernotomy. Baseline, perioperative, and follow‐up data were obtained and analyzed. Results The majority of patients had a history of breast cancer (n = 43), followed by Hodgkin lymphoma (n = 10) and non‐Hodgkin lymphoma (n = 3). Preoperative estimated mortality with the Euroscore II was 3.4%. Overall 30‐day mortality was 6.8% (n = 4), with a total in‐hospital mortality of 10.2% (n = 6). Postoperatively, nine rethoracotomies (15.3%) had to be performed. During a mean follow‐up of 53 months, an additional 10 patients (16.9%) died, of which 60% (n = 6) as a result of cancer‐related events. Cox proportional modeling showed no differences in mortality between primary malignancies (P > .05). Conclusion This study shows that cardiac surgery after mediastinal radiotherapy is associated with increased short‐ and long‐term mortality when compared to preoperative mortality risks predicted by the Euroscore II. Surgery‐related events caused all short‐term mortality cases, while malignancy‐related events were the main cause of death during the follow‐up. Mortality was higher in patients with a previous stroke and a lower estimated glomerular filtration rate.
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Affiliation(s)
- Onur B Dolmaci
- Department of Cardiothoracic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Emile S Farag
- Department of Cardiothoracic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - S Matthijs Boekholdt
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Wim J P van Boven
- Department of Cardiothoracic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Abdullah Kaya
- Department of Cardiothoracic Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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19
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Howard E, Steingart RM, Armstrong GT, Lyon AR, Armenian SH, Teresa Voso M, Cicconi L, Coco FL, Minotti G. Cardiovascular events in cancer survivors. Semin Oncol 2019; 46:426-432. [DOI: 10.1053/j.seminoncol.2019.01.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 01/09/2019] [Indexed: 11/11/2022]
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20
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Báez-Ferrer N, Izquierdo-Gómez MM, Beyello-Belkasem C, Jorge-Pérez P, García-González MJ, Ferrer-Hita JJ, De la Rosa-Hernández A, García-Niebla J, Lacalzada-Almeida J. Long-Term Radiotherapy-Induced Cardiac Complications: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1182-1188. [PMID: 31401643 PMCID: PMC6753667 DOI: 10.12659/ajcr.917224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patient: Male, 48 Final Diagnosis: Late cardiac complications postradiotherapy Symptoms: Chest pain • dyspnea • syncope Medication: — Clinical Procedure: Diagnostic and therapeutic techniques in cardiology Specialty: Cardiology
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Affiliation(s)
- Néstor Báez-Ferrer
- Department of Cardiology, University Hospital of the Canary Islands, Tenerife, Spain
| | | | | | - Pablo Jorge-Pérez
- Department of Cardiology, University Hospital of the Canary Islands, Tenerife, Spain
| | | | - Julio J Ferrer-Hita
- Department of Cardiology, University Hospital of the Canary Islands, Tenerife, Spain
| | | | - Javier García-Niebla
- Department of Cardiology, University Hospital of the Canary Islands, Tenerife, Spain
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21
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The Onco-cardiologist Dilemma: to Implant, to Defer, or to Avoid Transcatheter Aortic Valve Replacement in Cancer Patients with Aortic Stenosis? Curr Cardiol Rep 2019; 21:83. [DOI: 10.1007/s11886-019-1166-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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22
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Cardiovascular Complications Associated with Mediastinal Radiation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:31. [DOI: 10.1007/s11936-019-0737-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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23
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24
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Layoun ME, Yang EH, Herrmann J, Iliescu CA, Lopez-Mattei JC, Marmagkiolis K, Budoff MJ, Ferencik M. Applications of Cardiac Computed Tomography in the Cardio-Oncology Population. Curr Treat Options Oncol 2019; 20:47. [PMID: 31056717 PMCID: PMC8772342 DOI: 10.1007/s11864-019-0645-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OPINION STATEMENT The increased risk for cardiovascular events in aging cancer survivors and those undergoing certain chemotherapeutic treatments has raised concern for more rigorous screening and surveillance methods above that of the general population. At this time, there are limited guidelines for how to best manage this vulnerable cohort. Questions regarding timing of screening, choice of imaging modality and risk reduction strategies-especially in those patients with known atherosclerotic disease-remain to be elucidated. Over a decade of case series, retrospective studies and clinical trials have shed light on the evolving role of cardiac computed tomography (CT) in this population, of which there is a relative paucity of data regarding its potential utility in the specific cardio-oncology population. Focusing on ability of cardiac CT to evaluate multiple cardiac and vascular structures, provide diagnostic and prognostic information, as well as assist interventional and surgical colleagues in surgical/percutaneous valve replacement and revascularization strategies is the premise for this review.
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Affiliation(s)
- Michael E Layoun
- Knight Cardiovascular Institute, Division of Cardiology, Department of Medicine, Oregon Health & Science University, 3180 Sam Jackson Park Rd., Mail Code UHN62, Portland, OR, 97239, USA
| | - Eric H Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, CA, USA
| | - Joerg Herrmann
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Cezar A Iliescu
- Department of Cardiology, Division of Internal Medicine, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Juan C Lopez-Mattei
- Department of Cardiology, Division of Internal Medicine, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Kostas Marmagkiolis
- Premier Heart and Vascular Group, Florida Hospital Pepin Heart Institute, Tampa, FL, USA
| | - Matthew J Budoff
- Division of Cardiology, Department of Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Maros Ferencik
- Knight Cardiovascular Institute, Division of Cardiology, Department of Medicine, Oregon Health & Science University, 3180 Sam Jackson Park Rd., Mail Code UHN62, Portland, OR, 97239, USA.
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Melillo E, Ascione L, Palmiero G, Caso VM, Caso P. Transcatheter Aortic Valve Replacement and Cardiac Resynchronization Therapy in Cancer-Related Cardiotoxicity. J Cardiovasc Echogr 2018; 28:233-235. [PMID: 30746327 PMCID: PMC6341852 DOI: 10.4103/jcecho.jcecho_46_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Cardiotoxicity related to antineoplastic agents is a rising and growing issue, therefore early recognition and prompt management can impact on the overall prognosis of cancer patients. We report the case of a 70-year-old woman without cardiovascular risk factors, with a medical history of non-Hodgkin lymphoma and chronic myeloid leukemia treated with chemotherapy and radiotherapy, who underwent transcatheter aortic valve replacement for severe aortic stenosis and cardiac resynchronization therapy for further development of complete left bundle branch block, with a significant improvement of her functional status and left ventricle systolic function in a long-term follow-up.
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Affiliation(s)
- Enrico Melillo
- Department of Cardiology, Monaldi Hospital, AORN dei Colli, Naples, Italy
| | - Luigi Ascione
- Department of Cardiology, Monaldi Hospital, AORN dei Colli, Naples, Italy
| | - Giuseppe Palmiero
- Department of Cardiology, Monaldi Hospital, AORN dei Colli, Naples, Italy
| | | | - Pio Caso
- Department of Cardiology, Monaldi Hospital, AORN dei Colli, Naples, Italy
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26
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Ghoneim A, Bouhout I, Perrault LP, Bouchard D, Pellerin M, Lamarche Y, Demers P, Carrier M, Cartier R, El-Hamamsy I. Reexamining the Role of Surgical Aortic Valve Replacement After Mediastinal Radiation Therapy. Ann Thorac Surg 2017; 104:485-492. [DOI: 10.1016/j.athoracsur.2017.01.097] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 12/18/2016] [Accepted: 01/30/2017] [Indexed: 11/24/2022]
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27
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Ejiofor JI, Ramirez-Del Val F, Nohria A, Norman A, McGurk S, Aranki SF, Shekar P, Cohn LH, Kaneko T. The risk of reoperative cardiac surgery in radiation-induced valvular disease. J Thorac Cardiovasc Surg 2017; 154:1883-1895. [PMID: 28870399 DOI: 10.1016/j.jtcvs.2017.07.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 06/14/2017] [Accepted: 07/03/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Mediastinal radiation therapy (MRT) increases the risk for adverse outcomes after cardiac surgery and is not incorporated in the Society of Thoracic Surgeons (STS) risk algorithm. We aimed to quantify the surgical risk conferred by MRT in patients undergoing primary and reoperative valvular operations. METHODS A retrospective analysis of 261 consecutive patients with prior MRT who underwent valvular operations between January 2002 and May 2015. Short- and long-term outcomes were compared for STS predicted risk of mortality, surgery type, gender, year of surgery, and age-matched patients stratified by reoperative status. RESULTS Mean age was 62.6 ± 12.1 years and 174 (67%) were women. The majority had received MRT for Hodgkin lymphoma (48.2%) and breast cancer (36%). Overall, 214 (82%) were primary and 47 (18%) were reoperative procedures. Reoperation carried a higher operative mortality than primary cases (17% vs 3.7%; P = .003). Compared with the 836 nonradiated matches, operative mortality and observed-to-expected STS mortality ratios were higher in primary (3.8% [1.4] vs 0.8% [0.32]; P = .004) and reoperative (17% [3.35] vs 2.3% [0.45]; P = .001) patients with prior MRT. Cox proportional hazard modeling revealed that in patients with previous MRT, primary (hazard ratio, 2.24; 95% confidence interval, 1.73-2.91) and reoperative status (hazard ratio, 3.19; 95% confidence interval, 1.95-5.21) adversely affected long-term survival compared with nonradiated matches. CONCLUSIONS Surgery for radiation-induced valvular heart disease has a higher operative mortality than predicted by STS predicted risk of mortality. Reoperations are associated with increased morbidity and mortality compared with primary cases. Careful patient selection is paramount and expanded indications for transcatheter therapies should be considered, especially in reoperative patients.
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Affiliation(s)
- Julius I Ejiofor
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | | | - Anju Nohria
- Division of Cardiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Anthony Norman
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Siobhan McGurk
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Sary F Aranki
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Prem Shekar
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Lawrence H Cohn
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Tsuyoshi Kaneko
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
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Summers MR, Cremer PC, Jaber WA. Three mechanisms of early failure of transcatheter aortic valves: Valve thrombosis, cusp rupture, and accelerated calcification. J Thorac Cardiovasc Surg 2016; 153:e87-e93. [PMID: 28073568 DOI: 10.1016/j.jtcvs.2016.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 11/30/2016] [Accepted: 12/06/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Matthew R Summers
- Robert and Suzanne Tomisch Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Paul C Cremer
- Robert and Suzanne Tomisch Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Wael A Jaber
- Robert and Suzanne Tomisch Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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29
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Marlière S, Vautrin E, Saunier C, Chaikh A, Gabelle-Flandin I. [Radiation-related heart toxicity: Update in women]. Ann Cardiol Angeiol (Paris) 2016; 65:411-419. [PMID: 27842711 DOI: 10.1016/j.ancard.2016.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Breast cancer is a common diagnosis in women and thus women are at risk of radiation-induced heart disease, in particular during radiotherapy for left breast cancer and when the internal mammary chain is included. Rates of major cardiac events increase with younger age at the time of irradiation, diagnosis before 1990s, higher radiation doses, coexisting cardiovascular risk factors and adjuvant cardiotoxic chemotherapy. Radiation-induced heart disease comprises a spectrum of cardiac pathologies, including pericardial disease, cardiomyopathy, coronary artery disease and valvular disease. The cardiac injury can appear a long time after radiotherapy and can consist of complex lesions with poor prognosis. The disciplines of cardiology and oncology have increasingly recognized the benefits of collaborating in the care of cancer patients with cardiac disease, developing guidelines for the assessment and management of radiation-related cardiovascular disease. We could consider screening patients with previous chest radiation every 5 years with transthoracic echocardiography and functional imaging. However, prevention remains the primary goal, using cardiac sparing doses and avoidance techniques in radiotherapy to improve patient survival.
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Affiliation(s)
- S Marlière
- Clinique universitaire de cardiologie, centre hospitalier universitaire de Grenoble-Alpes, BP 217, 38043 Grenoble cedex 9, France.
| | - E Vautrin
- Clinique universitaire de cardiologie, centre hospitalier universitaire de Grenoble-Alpes, BP 217, 38043 Grenoble cedex 9, France
| | - C Saunier
- Clinique universitaire de cardiologie, centre hospitalier universitaire de Grenoble-Alpes, BP 217, 38043 Grenoble cedex 9, France
| | - A Chaikh
- Service de cancérologie-radiothérapie, centre hospitalier universitaire de Grenoble-Alpes, BP 217, 38043 Grenoble cedex 9, France
| | - I Gabelle-Flandin
- Service de cancérologie-radiothérapie, centre hospitalier universitaire de Grenoble-Alpes, BP 217, 38043 Grenoble cedex 9, France
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30
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Al-Kindi SG, Oliveira GH. Onco-Cardiology: A Tale of Interplay Between 2 Families of Diseases. Mayo Clin Proc 2016; 91:1675-1677. [PMID: 27916153 DOI: 10.1016/j.mayocp.2016.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 10/20/2016] [Indexed: 01/19/2023]
Affiliation(s)
- Sadeer G Al-Kindi
- Onco-Cardiology Program, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, OH
| | - Guilherme H Oliveira
- Onco-Cardiology Program, Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center and Case Western Reserve University, Cleveland, OH.
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Gujral DM, Lloyd G, Bhattacharyya S. Radiation-induced valvular heart disease. Heart 2015; 102:269-76. [PMID: 26661320 DOI: 10.1136/heartjnl-2015-308765] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 11/03/2015] [Indexed: 12/15/2022] Open
Abstract
Radiation to the mediastinum is a key component of treatment with curative intent for a range of cancers including Hodgkin's lymphoma and breast cancer. Exposure to radiation is associated with a risk of radiation-induced heart valve damage characterised by valve fibrosis and calcification. There is a latent interval of 10-20 years between radiation exposure and development of clinically significant heart valve disease. Risk is related to radiation dose received, interval from exposure and use of concomitant chemotherapy. Long-term outlook and the risk of valve surgery are related to the effects of radiation on mediastinal structures including pulmonary fibrosis and pericardial constriction. Dose prediction models to predict the risk of heart valve disease in the future and newer radiation techniques to reduce the radiation dose to the heart are being developed. Surveillance strategies for this cohort of cancer survivors at risk of developing significant heart valve complications are required.
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Affiliation(s)
- Dorothy M Gujral
- Department of Clinical Oncology, Imperial College Healthcare NHS Trust, London, UK
| | - Guy Lloyd
- Echocardiography Laboratory, Bart's Heart Centre, St Bartholomew's Hospital, London, UK Valvular Heart Disease Clinic, Bart's Heart Centre, St Bartholomew's Hospital, London, UK
| | - Sanjeev Bhattacharyya
- Echocardiography Laboratory, Bart's Heart Centre, St Bartholomew's Hospital, London, UK Valvular Heart Disease Clinic, Bart's Heart Centre, St Bartholomew's Hospital, London, UK
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