Novel concepts in radiation-induced cardiovascular disease

Figure 1 Severe calcification of proximal aorta and aortic leaflets (arrows) resulting in moderate aortic regurgitation and stenosis.

Figure 2 Apical four chamber view of mitral annular calcification (arrow).

Figure 3 Severe proximal stenosis of the left anterior descending coronary artery (arrow).

Figure 4 Radiation injury and the transition from acute inflammation to chronic fibrosis, as mediated by pro-fibrotic cytokines and reactive oxygen species. A-C: Normal tissue (A) becomes inflamed within hours of irradiation (B), and a pro-fibrotic cytokine profile predominates within days-to-weeks (C); D: Represents the chronic state of fibrosis characteristic of radiation injury. O₂^-: Reactive oxygen species; TNF-α: Tumor necrosis factor alpha; MCP-1: Monocyte chemotactic protein-1; CTGF: Connective tissue growth factor; TGF-β: Tumor growth factor beta; IL: Interleukin.

Figure 5 Proposed algorithm for cardio-oncologic screening following mediastinal radiotherapy[84]. CHF: Congestive heart failure; TTE: Transthoracic echocardiography.