The Reply

Abstract

We welcome and appreciate the Letter to the Editor written by Kaplan et al in reaction to our article entitled “Radiation-induced cardiac valve disease,”1Flores-Umanzor E.J. Hernandez-Enriquez M. Caldentey G. et al.Radiation-induced cardiac valve disease.Am J Med. 2017; 130: e99-e100Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar in which we described a case of radiation-induced valvular heart disease secondary to mantle radiation for Hodgkin's lymphoma at the age of 13 years, in a 42-year-old woman. As pointed out by the authors, there is a clear benefit of routine comprehensive cardiovascular screening and surveillance after exposure to ionizing radiation.2Heidenreich P.A. Hancock S.L. Lee B.K. et al.Asymptomatic cardiac disease following mediastinal irradiation.J Am Coll Cardiol. 2003; 42: 743-749Crossref PubMed Scopus (313) Google Scholar Unfortunately, our patient did not undergo cardiac screening after receiving radiation, and her first referral for cardiac evaluation took place because of progressive exertional dyspnea and signs of congestion, when severe aortic and mitral regurgitation were diagnosed. We would like to highlight that, although modern radiotherapy techniques are likely to reduce the prevalence and severity of radiation-induced cardiac disease, its incidence is expected to increase in cancer survivors who have received old radiotherapy regimens.3Lancellotti P. Nkomo V.T. Badano L.P. et al.Expert consensus for multi-modality imaging evaluation of cardiovascular complications of radiotherapy in adults: a report from the European Association of Cardiovascular Imaging and the American Society of Echocardiography.Eur Heart J Cardiovasc Imaging. 2013; 14: 721-740Crossref PubMed Scopus (232) Google Scholar A better knowledge of the real incidence of this pathologic entity would help the medical community to better evaluate and follow patients after chest radiotherapy. Large prospective studies with noninvasive imaging for comprehensive screening and surveillance of asymptomatic cancer survivors are needed and could help to determine adequate targeted follow-up, screening, and intervention in these patients. Survivorship After CancerThe American Journal of MedicineVol. 130Issue 10PreviewWe have read with interest the article by Flores-Umanzor et al,1 which discussed a case of radiation-induced valvular disease after mantle radiation. Valvular disease, cardiomyopathy, and accelerated atherosclerosis are well-documented late complications of chest radiation, especially when performed in the adolescent population. It is well documented that the cumulative incidence of cardiac disease is related to mediastinal radiation dose; however, appropriate follow-up for these patients to assess for radiation-induced cardiotoxicity is unclear. Full-Text PDF