Cardiac follow-up of cancer survivors.

Abstract

Should individuals with prior radiation therapy have routine cardiac stress testing to rule out coronary artery disease? Cancer survivors can have both short-term and long-term effects from both chemotherapy and radiation therapy. While most effects of chemotherapy occur in the acute setting, adverse events from radiation therapy typically take years and up to decades to present. The long-term cardiovascular (CV) effects of chest and mantel radiation therapy have been well documented and include pericarditis, coronary artery disease (CAD), valvular heart disease, and non-ischemic myocardial and conduction system damage. Ten years after radiation therapy, the risk of developing some type of radiation induced heart disease increases to approximately 40%. While routine testing of asymptomatic individuals for valvular disease with a transthoracic echocardiogram is relatively benign with standard guidelines for treatment irrespective of the aetiology; testing for coronary artery disease in asymptomatic individuals has more significant implications. Current expert opinion by the European Association of Cardiovascular Imaging and the American Society of Echocardiography recommend screening with a functional non-invasive stress test in asymptomatic individuals for CAD detection 5–10 years after exposure in high-risk patients with reassessment every 5 years.1 While these are opinions, and not guidelines, the true impact of screening asymptomatic patients is unclear and consideration should be given to whether this is the best practice. Radiation therapy leads to arteritis of the endothelium over time, typically taking 10–15 years to be seen on a macrovascular level. Arteritis from chest radiation, as is given for treatment of …