Late onset radiation-induced constrictive pericarditis and cardiomyopathy after radiotherapy

Abstract

Introduction:Radiation-induced heart disease (RIHD) is a serious side effect of cancer treatment, including coronary artery disease, valvular cardiac dysfunction, cardiomyopathy, aortopathy, and chronic constrictive pericarditis. Herein, this case we present was diagnosed as radiation-induced constrictive pericarditis and cardiomyopathy by means of cardiac magnetic resonance (CMR) and transthoracic echocardiogram, finally confirmed by pathology after performing heart transplant operation.Conclusions:This case supports a notion that RIHD often causes multiple heart impairment and CMR is helpful to diagnose cardiomyopathy after radiation.

Definition of the margin of major coronary artery bifurcations during radiotherapy with electrocardiograph-gated 4D-CT

“…Radiotherapy improves the life expectancy of patients with thoracic malignant tumors; simultaneously, radiation-induced heart disease (RIHD) has been documented with the development of treatment-associated cardiac toxic effects. These effects could cause widespread concern about the problem of RIHD [1][2][3]. RIHD includes radiationinduced pericarditis, myocarditis, coronary artery disease (CAD), valvular heart disease, and conduction system disease [1][2][3].…”

“…These effects could cause widespread concern about the problem of RIHD [1][2][3]. RIHD includes radiationinduced pericarditis, myocarditis, coronary artery disease (CAD), valvular heart disease, and conduction system disease [1][2][3]. Radiationinduced CAD generally has a long latent period of clinical toxicity and may significantly reduce the quality of patients' survival and even lead to death [4].…”

Cardiovascular complications after radiotherapy

“…These conditions include acute pericarditis, chronic pericarditis, chronic pericardial effusion, and constrictive pericarditis. They mostly develop in patients treated with a radiation dose of at least 50 Gy [39]. Treatment decisions depend on the type of pericardial disease and the clinical condition of the patient [3,40].…”

“…Radiotherapy-induced cardiac damage leads to myocardial fibrosis [39,51] which mostly results in LV diastolic dysfunction. The main mechanism underlying cardiomyocytes injury is microvascular damage.…”

Cardiovascular magnetic resonance (CMR) in restrictive cardiomyopathies

“…The quantitative biventricular functional assessment offered by cine sequences is recommended in those with suboptimal TTE or discrepant results on 2016 ESC Position Paper on Cancer Treatments and Cardiovascular Toxicity [57]. Pericardial thickening is also frequent in those patients [58].…”