Davis Margot, Witteles Ronald M
Division of Cardiovascular Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Falk Cardiovascular Research Center #273, Stanford, CA, 94305-5406, USA.
Curr Treat Options Cardiovasc Med. 2014 Jun;16(6):317. doi: 10.1007/s11936-014-0317-2.
Radiation-induced heart disease (RIHD) represents a spectrum of cardiovascular disease in patients who have undergone mediastinal, thoracic, or breast radiotherapy (RT). RIHD may involve any cardiac structure and is a major cause of morbidity and mortality in cancer survivors. While large cohort studies have demonstrated that symptomatic RIHD is a common late finding in this population, the incidence of asymptomatic disease is likely to be even higher. Long-term follow-up with regular screening for RIHD plays an important role in the management of cancer survivors who have undergone RT. Aggressive modification of traditional cardiovascular risk factors such as hypertension, dyslipidemia, and cigarette smoking is essential in patients at risk for RIHD, as these have been shown to potentiate the risks of radiation. In patients with symptomatic RIHD, medical and/or percutaneous therapies are often preferable to surgical interventions in view of the increased surgical risk associated with radiation damage to surrounding tissues. Percutaneous revascularization should generally be favored over surgical revascularization. Transcatheter valve replacements have not been widely used in this population but may offer an alternative to high-risk surgical valve procedures. Pericardiectomy is usually associated with extremely poor short-term and long-term outcomes in patients with RIHD and should be avoided in most cases. Heart transplantation is also higher risk in patients with RIHD than in patients with other etiologies of heart failure, but may be considered in young patients without other comorbidities.
放射性心脏病（RIHD）是指接受纵隔、胸部或乳腺放疗（RT）的患者所患的一系列心血管疾病。RIHD可累及任何心脏结构，是癌症幸存者发病和死亡的主要原因。虽然大型队列研究表明，有症状的RIHD是该人群常见的晚期表现，但无症状疾病的发生率可能更高。对RIHD进行定期筛查的长期随访在接受RT的癌症幸存者管理中起着重要作用。积极改变传统心血管危险因素，如高血压、血脂异常和吸烟，对有RIHD风险的患者至关重要，因为这些因素已被证明会增加辐射风险。对于有症状的RIHD患者，鉴于与周围组织辐射损伤相关的手术风险增加，药物和/或经皮治疗通常比手术干预更可取。经皮血管重建术一般应优于外科血管重建术。经导管瓣膜置换术在该人群中尚未广泛应用，但可能为高风险的外科瓣膜手术提供替代方案。心包切除术在RIHD患者中通常与极差的短期和长期预后相关，在大多数情况下应避免。与其他病因的心力衰竭患者相比，RIHD患者进行心脏移植的风险也更高，但对于没有其他合并症的年轻患者可考虑进行。
