Cardiology IV, "A.De Gasperis" Department, ASTT GOM Niguarda Ca' Granda, Milan, Italy; School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Radiother Oncol. 2020 Nov;152:146-150. doi: 10.1016/j.radonc.2020.07.004. Epub 2020 Jul 15.
Radiation Induced Heart Disease (RIHD) represents a late effect of chest irradiation, contributing in increasing mortality rate in oncological patients by affecting pericardium, myocardium, valvs and coronaries. Currently, regarding the risk of Coronary Artery Disease (CAD), a cardiological screening involving exercise stress electrocardiography after 5-10 years from radiotherapy is advised. We sought to determine the rate of ischemia at exercise stress electrocardiography in a population of patients without cardiovascular risk factors who sustained radiotherapy, using a cohort of patients presenting with at least one cardiovascular risk factor as control group.
A population of 115 patients who sustained chest irradiation (and associated chemotherapy), presenting without classic cardiovascular risk factors or typical symptoms suggesting CAD, was evaluated with exercise stress electrocardiography. 135 patients with at least one risk factor for cardiovascular disease candidate to stress testing for primary prevention or for atypical symptoms served as control group.
The cohort of irradiated patients without classical cardiovascular risk factors is younger (48.7 ± 10.1 vs 60.5 ± 10.8 years, p < 0.001) and presents a lower percentage of males when compared with the control group. In this latter group 25.9% of subjects has diabetes, 62.9% dyslipidaemia, 67.4% hypertension and 19.2% actively smoke. Despite this important differences regarding classic cardiovascular risk factors, no significant differences were found in the number of positive exercise stress electrocardiography (10.4 vs 5.9%, p = ns).
Chest irradiation represents a strong cardiovascular risk factor. In fact, prevalence of positive ECG-stress test is not different (nor higher and nor lower) in irradiated subjects without cardiovascular risk and not irradiated patients with classic cardiovascular risk.
放射性心脏病（RIHD）是胸部放疗的一种晚期效应，通过影响心包、心肌、瓣膜和冠状动脉，增加了肿瘤患者的死亡率。目前，对于冠心病（CAD）的风险，建议在放疗后 5-10 年内进行包括运动负荷心电图在内的心血管筛查。我们旨在确定一组无心血管危险因素的放疗患者在运动负荷心电图检查中出现缺血的比率，并将其与至少存在一个心血管危险因素的患者作为对照组。
评估了 115 例接受胸部放疗（伴或不伴化疗）且无典型心血管危险因素或提示 CAD 典型症状的患者，行运动负荷心电图检查。135 例有至少一个心血管疾病危险因素（适合进行一级预防或有不典型症状的患者）作为对照组。
无经典心血管危险因素的放疗患者更年轻（48.7±10.1 岁比 60.5±10.8 岁，p<0.001），且男性比例低于对照组。在对照组中，25.9%的患者患有糖尿病，62.9%的患者存在血脂异常，67.4%的患者患有高血压，19.2%的患者吸烟。尽管两组在经典心血管危险因素方面存在显著差异，但运动负荷心电图阳性的比例无显著差异（10.4%比 5.9%，p=ns）。
胸部放疗是一个强烈的心血管危险因素。事实上，在无心血管危险因素的放疗患者和有经典心血管危险因素的未放疗患者中，心电图运动负荷试验阳性的发生率并无差异（既不更高，也不更低）。
