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Table 2 Most common RT and ChT-induced myocardial damage

From: Imaging side effects and complications of chemotherapy and radiation therapy: a pictorial review from head to toe

Treatment Pathophysiology Myocardial disease Coronary CT Cardiac MRI
RT Endothelial injury and inflammation leading to endothelial dysfunction and acceleration of the atherosclerotic process in the coronary vessels and chronic collagen deposition lead to fibrosis of soft tissues CAD CAD Perfusion defect in case of obstructive coronary artery disease
Valvular disease Diffuse thickening of leaflets with calcifications in late stages Fibrotic thickening and enhancement of leaflets with dysfunction (stenosis or regurgitation) in late stages
Constrictive pericarditis Increased pericardial thickness
Pericardial calcifications
Increased pericardial thickness with delayed enhancement
Pericardial calcifications
Septal flattening or bounce
Inspiratory septal shift
Cardiomyopathy Non-obstructive CAD Increased ECV for fibrosis
10% decline of EF or EF < 50%
ChT Mitochondrial dysfunction, inflammation, oxidative stress, with cardiomyocyte apoptosis and necrosis, and replacement fibrosis (with reported dose-dependent mechanism) Myocarditis (early toxicity) Non-obstructive CAD Slightly altered T2 mapping and ECV with or without preserved EF
Cardiomyopathy Non-obstructive CAD Increased ECV for diffuse fibrosis
10% decline of EF or EF < 50% in late and irreversible stage
ICI The pathological mechanism is not fully understood, it seems to be related to hyperactivation of the immune system
Histological evidences of upregulation of inflammatory cytokines and of massive inflammatory cell infiltration
Pericarditis Pericardial thickening and enhancement
Pericardial effusion
Pericardial thickening, edema and enhancement
Pericardial effusion
Myocarditis Non-obstructive CAD Diffuse myocardial edema, increased native T1, T2 and ECV
LGE with non-ischemic pattern
Other myocardial diseases (rare) Non-obstructive CAD Stress cardiomyopathy (rapid EF recovery) and Takotsubo-like cardiomyopathy
Ischemic LGE for myocardial infarction (due to vasospasm)
  1. RT, radiation therapy; ChT, chemotherapy; ICI, immune checkpoint inhibitors; CAD, coronary artery disease; EF, ejection fraction; T1, native T1 mapping; ECV, extracellular volume fraction; LGE, late gadolinium enhancement