Thoracic radiotherapy as a risk factor for heart ischemia in subjects with chest irradiation and without classic cardiovascular risk factors

Introduction: Radiation induced heart disease (RIHD) represents a late effect of chest irradiation, contributing in augmenting mortality in oncological patients by affecting pericardium, myocardium, valves and coronaries. Currently, regarding the risk of coronary heart disease (CAD), a cardiological screening involving exercise stress electrocardiography after 5–10 years from radiotherapy is advised. Aim: We sought to determine the rate of ischemia at exercise stress electrocardiography in a population of patient without cardiovascular risk factors who sustained radiotherapy, using a cohort of high cardiovascular risk patients as control group. Methods: A population of 115 patients who sustained chest irradiation, presenting without classic cardiovascular risk factors was evaluated with exercise stress electrocardiography. 135 patients with high profile of cardiovascular risk candidate to stress testing for primary prevention or for atypical symptoms served as control group. Results: The cohort of irradiated patients without classical cardiovascular risk factors was 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% dyslipidemia, 67.4% hypertension and 19.2% actively smoke. Despite this important differences regarding classic cardiovascular risk factor no significant differences were founded in the number of positive exercise stress electrocardiography (10.4 vs 5.9%, p = ns). Conclusions: Chest irradiation represent a strong cardiovascular risk factor, equalizing the rate of positive exercise stress electrocardiograms among two cohort of patients significantly different for the rate of classic cardiovascular risk factors.