Radiation induced coronary artery disease – RICAD

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Radiation induced coronary artery disease – RICAD

Radiation induced coronary artery disease (RICAD) is an important long term sequelae of radiotherapy to the chest region. The most common conditions associated with RICAD are breast cancer and Hodgkin’s lymphoma. The risk is higher in Hodgkin’s lymphoma because they receive a higher dose of radiotherapy [1]. It may be noted that radiation is used in the treatment of about 50% of cancers [2]. Hence the importance of RICAD.

Radiation causes vascular endothelial injury. It initiates and accelerates atherosclerosis. Proinflammatory cytokines were increased in the blood of long term survivors of atomic bomb, suggesting a systemic inflammatory state [3].

Even though RICAD is in general more common in older patients, younger patients have also been reported [4]. One 30 year old male with radiation 15 years prior had total occlusion of proximal left anterior descending coronary artery and 90% stenosis of proximal right coronary artery. Emergency angioplasty with stenting was done. Another 31 year old female with radiation 8 years prior had left ventricular dysfunction (ejection fraction 35%) and 99% proximal left main coronary artery stenosis. She underwent successful coronary artery bypass grafting. The third person was a 25 year old male who radiation for spinal tumour 9 years prior. He had left ventricular dysfunction, moderate aortic regurgitation, severe calcification of aortic and mitral valves and 99% left main coronary artery stenosis. But he did not survive after coronary artery bypass grafting [4].

References

  1. Brown KN, Richards JR. StatPearls [Internet].
  2. Delaney G, Jacob S, Featherstone C, Barton M. The role of radiotherapy in cancer treatment: estimating optimal utilization from a review of evidence-based clinical guidelines. Cancer. 2005 Sep 15;104(6):1129-37.
  3. Venkatesulu BP, Mahadevan LS, Aliru ML, Yang X, Bodd MH, Singh PK, Yusuf SW, Abe JI, Krishnan S. Radiation-Induced Endothelial Vascular Injury: A Review of Possible Mechanisms. JACC Basic Transl Sci. 2018 Aug;3(4):563-572.
  4. Ruiz CR, Mesa-Pabón M, Soto K, Román JH, López-Candales A. Heart Views. 2018 Jan-Mar;19(1):23-26.