Coronary Artery Findings After Left-Sided Compared With Right-Sided Radiation Treatment for Early-Stage Breast Cancer

2007 ◽  
Vol 25 (21) ◽  
pp. 3031-3037 ◽  
Author(s):  
Candace R. Correa ◽  
Harold I. Litt ◽  
Wei-Ting Hwang ◽  
Victor A. Ferrari ◽  
Lawrence J. Solin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Coronary Artery ◽  
Stress Testing ◽  
Radiation Treatment ◽  
Early Stage ◽  
Breast Conservation ◽  
Cardiac Stress ◽  
Coronary Stenoses ◽  
Cardiac Stress Testing ◽  
Artery Disease

PurposeTo compare the incidence and distribution of coronary artery disease after left-sided versus right-sided irradiation in patients treated with breast conservation for early-stage breast cancer who subsequently underwent cardiac stress testing and/or catheterization for cardiovascular symptoms.Patients and MethodsThe medical records of 961 stage I-II breast cancer patients treated from 1977 to 1995 at the University of Pennsylvania with conventional tangential beam radiation treatment (RT) were screened for cardiac stress tests and catheterizations performed after RT. The results of these tests were analyzed by laterality of RT and compared with baseline cardiovascular risk.ResultsAt diagnosis, patients with left-sided and right-sided breast cancer had the same estimated 10-year risk (both 7%) of developing coronary artery disease. At a median time of 12 years post-RT (range, 2 to 24 years), 46 patients with left-sided and 36 patients with right-sided breast cancer (total, N = 82) had undergone cardiac stress testing. A statistically significant higher prevalence of stress test abnormalities was found among left (27 of 46; 59%) versus right-side irradiated patients (three of 36; 8%; P = .001). Furthermore, 19 of 27 of left-sided abnormalities (70%) were in the left anterior descending artery territory. Thirteen left-side irradiated patients also underwent cardiac catheterization revealing 12 of 13 with coronary stenoses (92%) and eight of 13 with coronary stenoses (62%) solely in the left anterior descending artery.ConclusionPatients treated with left-sided radiation as a component of breast conservation have an increased risk of late, radiation-associated coronary damage. Treatment with modern radiation techniques may reduce the risk of cardiac injury.

Late Cardiac Mortality and Morbidity in Early-Stage Breast Cancer Patients After Breast-Conservation Treatment

2006 ◽  
Vol 24 (25) ◽  
pp. 4100-4106 ◽  
Author(s):  
Eleanor E.R. Harris ◽  
Candace Correa ◽  
Wei-Ting Hwang ◽  
Jessica Liao ◽  
Harold I. Litt ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Breast Conservation ◽  
Cardiac Mortality ◽  
Mortality And Morbidity ◽  
Conservation Treatment ◽  
Breast Conservation Treatment ◽  
Artery Disease

Purpose Several studies have reported increased cardiac mortality related to the use of left-sided breast or chest-wall irradiation. This study was undertaken as a comprehensive examination of the long-term cardiac mortality and morbidity after breast irradiation using contemporary irradiation techniques. Methods The medical records of 961 consecutive patients presenting between 1977 and 1994 with stage I or II breast cancer treated with breast conservation treatment were reviewed. Data was recorded on baseline pretreatment patient, tumor and treatment characteristics and on subsequent cancer or cardiac related events. The median follow-up time was 12 years. Results There was no difference in overall mortality from any cardiac cause (P = .25). Death from any cardiac cause occurred in 2% of right-sided patients and 3.5% of left-sided patients. However, in the second decade after treatment, there was a higher rate of cardiac deaths in left-sided patients, with a cumulative risk of 6.4% (95% CI, 3.5% to 11.5%) for left-sided compared with 3.6% (95% CI, 1.8% to 7.2%) for right-sided patients at 20 years. There were statistically higher rates of chest pain, coronary artery disease, and myocardial infarction diagnosed in left-sided patients (all P ≤ .002). The presence of hypertension was associated with a higher risk of coronary artery disease in left-sided patients. Conclusion Irradiation to the left breast is not associated with a higher risk of cardiac death up to 20 years after treatment, but is associated with an increased rate of diagnoses of coronary artery disease and myocardial infarction compared with right breast treatment.

scholarly journals Relation of abnormal cardiac stress testing with outcomes in patients undergoing renal transplantation

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260718
Author(s):  
Kelsey Anderson ◽  
Chirag Bavishi ◽  
Dhaval Kolte ◽  
Reginald Gohh ◽  
James A. Arrighi ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Renal Transplant ◽  
Stress Testing ◽  
Stress Test ◽  
Major Adverse Cardiovascular Events ◽  
Cardiac Stress ◽  
Cardiac Stress Testing ◽  
Artery Disease ◽  
Test Result

Cardiovascular risk stratification is often performed in patients considered for renal transplantation. In a single center, we sought to examine the association between abnormal stress testing with imaging and post-renal transplant major adverse cardiovascular events (MACE) using multivariable logistic regression. From January 2006 to May 2016 232 patients underwent renal transplantation and 59 (25%) had an abnormal stress test result. Compared to patients with a normal stress test, patients with an abnormal stress test had a higher prevalence of dyslipidemia, diabetes mellitus, obesity, coronary artery disease (CAD), and heart failure. Among those with an abnormal result, 45 (76%) had mild, 10 (17%) moderate, and 4 (7%) severe ischemia. In our cohort, 9 patients (3.9%) had MACE at 30-days post-transplant, 5 of whom had an abnormal stress test. The long-term MACE rate, at a median of 5 years, was 32%. After adjustment, diabetes (OR 2.37, 95% CI 1.12–5.00, p = 0.02), CAD (OR: 3.05, 95% CI 1.30–7.14, p = 0.01) and atrial fibrillation (OR: 5.86, 95% CI 1.86–18.44, p = 0.002) were independently associated with long-term MACE, but an abnormal stress test was not (OR: 0.83, 95% CI 0.37–1.92, p = 0.68). In conclusion, cardiac stress testing was not an independent predictor of long-term MACE among patients undergoing renal transplant.

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