How to prevent and manage radiation-induced coronary artery disease.
How to prevent and manage radiation-induced coronary artery disease.
复制标题
DOI：
10.1136/heartjnl-2017-312123
复制
发表时间：
2018-10
期刊：
影响因子：
--
通讯作者：
Weintraub NL
中科院分区：
文献类型：
--
作者：
Cuomo JR;Javaheri SP;Sharma GK;Kapoor D;Berman AE;Weintraub NL
放射诱发的冠心病（RICHD）是乳腺癌、霍奇金淋巴瘤和其他常见纵隔恶性肿瘤放疗患者发病率和死亡率的第二大常见原因。RICHD的风险随着辐射剂量的增加而增加。暴露的患者可能在治疗后数十年表现为无症状心肌灌注缺损、开口、三支血管疾病和心源性猝死。RICHD是潜伏性的，潜伏期长，并且在病程后期倾向于保持沉默。血管受累通常是弥漫性的，并且优先发生在近端。病理生理学与加速动脉粥样硬化相似，其特征在于形成具有高胶原和纤维蛋白含量的炎性斑块。常规危险因素的存在会加重RICHD，理想情况下应在放射治疗前开始积极的危险因素管理。负荷超声心动图比心肌灌注成像在RICHD的检测中更敏感和特异，CT冠状动脉造影在危险分层中显示出希望。冠状动脉旁路移植术与RICHD患者移植失败、围手术期并发症和全因死亡率的风险较高相关。在大多数情况下，药物洗脱支架的使用优于外科手术、裸金属支架植入术或单纯球囊血管成形术。
Radiation-induced coronary heart disease (RICHD) is the second most common cause of morbidity and mortality in patients treated with radiotherapy for breast cancer, Hodgkin’s lymphoma and other prevalent mediastinal malignancies. The risk of RICHD increases with radiation dose. Exposed patients may present decades after treatment with manifestations ranging from asymptomatic myocardial perfusion defects to ostial, triple-vessel disease and sudden cardiac death. RICHD is insidious, with a long latency and a tendency to remain silent late into the disease course. Vessel involvement is often diffuse and is preferentially proximal. The pathophysiology is similar to that of accelerated atherosclerosis, characterised by the formation of inflammatory plaque with high collagen and fibrin content. The presence of conventional risk factors potentiates RICHD, and aggressive risk factor management should ideally be initiated prior to radiation therapy. Stress echocardiography is more sensitive and specific than myocardial perfusion imaging in the detection of RICHD, and CT coronary angiography shows promise in risk stratification. Coronary artery bypass grafting is associated with higher risks of graft failure, perioperative complications and all-cause mortality in patients with RICHD. In most cases, the use of drug-eluting stents is preferable to surgical intervention, bare metal stenting or balloon-angioplasty alone.
登录
查看更多内容
影响因子：
158.5
作者：
Darby, Sarah C.;Ewertz, Marianne;Hall, Per
通讯作者：
Hall, Per
影响因子：
51.1
作者：
Darby, SC;McGale, P;Peto, R
通讯作者：
Peto, R
影响因子：
120.7
作者：
Gartner, Rune;Jensen, Maj-Britt;Kehlet, Henrik
通讯作者：
Kehlet, Henrik
影响因子：
50.5
作者：
Daniels, L. A.;Krol, A. D. G.;Creutzberg, C. L.
通讯作者：
Creutzberg, C. L.
影响因子：
37.8
作者：
CHAITMAN, BR;BOURASSA, MG;KILLIP, T
通讯作者：
KILLIP, T