Table 3 Management Recommendations for the Prevention and Detection of Radiation-induced Valvular Heart Disease

2

Assess risk factors for developing VHD: anterior or left-sided chest wall irradiation, exposure to a high cumulative dose of radiation (> 30 Gy) or a high daily fraction of radiation > 2 Gy, lack of shielding, young age at radiotherapy (< 50 years), concomitant chemotherapy, presence of pre-existing cardiovascular disease, or presence of cardiovascular risk factors (diabetes mellitus, hypertension, hyperlipidemia, obesity, and smoking)

3

For individuals with symptoms or murmur, check echocardiography

4

For low-risk asymptomatic individuals, screening for VHD with echocardiography is recommended at 10 years

5

For high-risk asymptomatic individuals, surveillance imaging for VHD should begin sooner, typically at 5 years

6

Asymptomatic individuals should undergo surveillance imaging every 5 years if initial screening echo is normal

7

Optimal management of underlying cardiovascular risk factors (hypertension, diabetes, hyperlipidemia, smoking, obesity, sedentary lifestyle, obstructive sleep apnea) is imperative