Physicians' Academy for Cardiovascular Education

Risk of heart failure increases with cardiac exposure radiotherapy in breast cancer patients

Risk of Heart Failure with Preserved Ejection Fraction in Older Women After Contemporary Radiotherapy for Breast Cancer

Saiki H, Petersen IA, Scott CG, et al. - Circulation, 2017, [Epub ahead of print]

Background

Standard treatment for breast cancer patients currently comprises breast conserving surgery plus radiotherapy. However, cardiac radiation during this therapy, even low levels, increases the risk of coronary events [1]. Although cardiomyocytes are resistant to radiation, it induces coronary microvascular endothelial damage and inflammation leading to microvascular rarefaction and myocardial inflammation, oxidative stress and fibroses [2-5]. A growing number of radiotherapy techniques can reduce cardiac exposure, but these are inconsistently utilized [6].

To investigate whether cardiac radiation exposure during contemporary breast cancer radiotherapy may increase the risk of heart failure (HF), in particularly HF with preserved ejection fraction (HFpEF), a population-based case-control study of breast cancer patients treated with CT-guided radiotherapy has been performed.

Main results

Conclusion

The odds of incident HF after radiotherapy increased with higher MCRD with predominantly HFpEF or HF with ‘mid-range’ (40-49%) EF and HF began within a few years after radiotherapy. Furthermore, these odds increased with MCRD, even after adjustment for other known risk factors and cancer stage. The current data also underscore the need to reduce MCRD, particularly in older women with HF risk factors, and the importance of techniques to reduce cardiac dose.

References

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Find this article online at Circulation