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Valvular Heart Disease Associated With Radiation Therapy: A Contemporary Review.

ABSTRACT: Valvular heart disease can develop as a long-term side effect of radiation therapy, along with other cardiovascular complications. The timeline until clinically significant disease can be on the order of decades, with left-sided valves most commonly affected. Only a few retrospective studies have characterized the incidence and findings associated with radiation therapy associated valvular heart disease. Furthermore, treatment can be difficult in this population given certain factors that can contribute to high surgical risk. In recent years, however, the development of transcatheter options for valvular disease has led to expanded eligibility criteria for cancer patients who may receive radiation therapy as part of their treatment course. We therefore sought to review the literature on radiation-induced valvular heart disease and provide an overview of recent studies on post-intervention outcomes in these patients.

SUBMITTER: Lee C

PROVIDER: S-EPMC10236812 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

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Valvular Heart Disease Associated With Radiation Therapy: A Contemporary Review.

Lee Charlotte C Hahn Rebecca T RT

Structural heart : the journal of the Heart Team 20221031 2

Valvular heart disease can develop as a long-term side effect of radiation therapy, along with other cardiovascular complications. The timeline until clinically significant disease can be on the order of decades, with left-sided valves most commonly affected. Only a few retrospective studies have characterized the incidence and findings associated with radiation therapy associated valvular heart disease. Furthermore, treatment can be difficult in this population given certain factors that can co ...[more]

PMID: 37275597

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Project description:AimsThe aim of this survey is to analyze how current recommendations on valvular heart disease (VHD) management have been adopted. Identifying potential discrepancies between recommendations and everyday clinical practice would enable us to better understand and address the remaining challenges in this controversial and complex field.Methods and resultsA total of 33 questions, distributed via email to all European Society of Cardiology (ESC) affiliated countries through the newsletter of the ESC council on VHD, were answered by 689 respondents, mainly from tertiary care settings. The results of this survey showed that VHD patients are mostly managed by tertiary care centres, where multi-disciplinary heart teams are frequently a reality. Cardiac computed tomography (CT) is often used in the preprocedural planning of transcatheter interventions, particularly for sizing and deliverability assessment. Echocardiography represents the most widely used imaging modality in the diagnostic, intra-operative and follow-up phase of VHD patients. Cardiac magnetic resonance (CMR) is still largely underused, also for conditions such as mitral annular disjunction, or for the assessment of left ventricle volumes where it is considered as the gold standard, despite 3D volumes by echocardiography having proved good comparability with CMR. As for endocarditis, despite still underused, transesophageal echocardiography (TEE) represents the approach of choice for the diagnosis of native and prosthesis valve endocarditis (up to 46% of the respondents use it). In this context, positron emission tomography-CT is largely underused.ConclusionThere is widespread adoption of current recommendation on the evaluation of VHD and these are frequently used to guide patient management. Nonetheless, there are still many discrepancies across centres and countries which need to be addressed with the aim of improving patients' management and outcomes and ultimately positively impacting on healthcare resources.

Project description:Background While many clinical prediction models (CPMs) exist to guide valvular heart disease treatment decisions, the relative performance of these CPMs is largely unknown. We systematically describe the CPMs available for patients with valvular heart disease with specific attention to performance in external validations. Methods and Results A systematic review identified 49 CPMs for patients with valvular heart disease treated with surgery (n=34), percutaneous interventions (n=12), or no intervention (n=3). There were 204 external validations of these CPMs. Only 35 (71%) CPMs have been externally validated. Sixty-five percent (n=133) of the external validations were performed on distantly related populations. There was substantial heterogeneity in model performance and a median percentage change in discrimination of -27.1% (interquartile range, -49.4%--5.7%). Nearly two-thirds of validations (n=129) demonstrate at least a 10% relative decline in discrimination. Discriminatory performance of EuroSCORE II and Society of Thoracic Surgeons (2009) models (accounting for 73% of external validations) varied widely: EuroSCORE II validation c-statistic range 0.50 to 0.95; Society of Thoracic Surgeons (2009) Models validation c-statistic range 0.50 to 0.86. These models performed well when tested on related populations (median related validation c-statistics: EuroSCORE II, 0.82 [0.76, 0.85]; Society of Thoracic Surgeons [2009], 0.72 [0.67, 0.79]). There remain few (n=9) external validations of transcatheter aortic valve replacement CPMs. Conclusions Many CPMs for patients with valvular heart disease have never been externally validated and isolated external validations appear insufficient to assess the trustworthiness of predictions. For surgical valve interventions, there are existing predictive models that perform reasonably well on related populations. For transcatheter aortic valve replacement (CPMs additional external validations are needed to broadly understand the trustworthiness of predictions.

Dataset Information

Valvular Heart Disease Associated With Radiation Therapy: A Contemporary Review.

Publications

Valvular Heart Disease Associated With Radiation Therapy: A Contemporary Review.

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