背景胸部放疗是一种广泛使用的胸部肿瘤治疗和姑息性治疗选择。然而,辐射暴露的短期和长期心血管不良反应仍然是一个主要问题.短期不良反应在暴露后数月内观察到，如心包疾病；同时，长期并发症通常是阴险的，几十年来明显的，比如充血性心力衰竭，冠状动脉疾病,心肌病,传导障碍,缩窄性心包炎,和心脏瓣膜病.因此，长期的心血管不良反应很难预测，与辐射暴露的关联仍然难以建立。方法本回顾性研究，观察性研究使用2016年至2019年国家住院患者样本(NIS)数据库的数据进行.使用主要和次要国际疾病分类定义接受放射治疗（RT）的原发性胸部恶性肿瘤的成年患者，第十修订代码。可以用RT治疗的其他恶性肿瘤和所有继发性恶性肿瘤从主要对照组中排除。心脏结果定义为充血性心力衰竭的患病率，冠状动脉疾病,心肌病,传导障碍,心包疾病,和原发性心脏瓣膜病。多变量逻辑和线性回归分析用于校正混杂因素。结果与普通人群相比，暴露于RT的胸部恶性肿瘤的成年人患慢性心包炎的几率较高（校正比值比（aOR）=2，95％置信区间（CI）=1.9-2.2，p<0.001），急性心包炎（aOR=2.3，95%CI=1.9-2.9，p<0.001），缩窄性心包炎(aOR=2.8,95%CI=2.1-3.7,p<0.001),传导障碍（aOR=1.3，95%CI=1.2-1.35，p<0.001），冠状动脉疾病（aOR=1.24，95%CI=1.2-1.27，p<0.001），心力衰竭（aOR=1.44，95%CI=1.4-1.5，p<0.001），和心脏瓣膜病(aOR=1.37,95%CI=1.3-1.4,p<0.001)。发生心脏骤停（aOR=1，95％CI=0.9-1.10，p=0.6）或急性心肌梗死（aOR=1.1，95％CI=1-1.15，p<0.001）的几率没有差异。与未暴露于RT的患有胸部恶性肿瘤的成年人相比，暴露于RT的患有胸部恶性肿瘤的成年人发生急性心肌梗死的几率更高（aOR=1.14，95％CI=1.1-1.18，p<0.001），慢性心包炎（aOR=1.3，95%CI=1.2-1.3，p<0.001），急性心包炎（aOR=1.6，95%CI=1.2-2.1，p<0.001），缩窄性心包炎(aOR=2.2,95%CI=1.5-3.2,p<0.001),传导障碍（aOR=1.1，95%CI=1.08-1.13，p<0.001），冠状动脉疾病（aOR=1.14，95%CI=1.12-1.16，p<0.001），心力衰竭（aOR=1.2，95%CI=1.17-1.23，p<0.001），和瓣膜性心脏病（aOR=1.3，95%CI=1.2-1.35，p<0.001）。两组发生心脏骤停的几率相似(aOR=0.86,95%CI=0.8-0.98,p=0.05)。结论接受RT治疗的患有胸部恶性肿瘤的成年人患慢性心包炎的几率更高，急性心包炎,缩窄性心包炎,传导障碍,冠状动脉疾病,心力衰竭,与普通成年人相比，心脏瓣膜病和心脏瓣膜病发生心脏骤停或急性心肌梗死的几率相似。
Background Thoracic irradiation is a widely used therapeutic and palliative treatment option for thoracic neoplasms. However, short- and long-term cardiovascular adverse effects of radiation exposure remain a major concern. The short-term adverse effects are observed within months of exposure such as pericardial diseases; meanwhile, the long-term complications are usually insidious and manifest over decades, such as congestive heart failure, coronary artery disease, cardiomyopathy, conduction disorders, constrictive pericarditis, and valvular heart disease. Hence, long-term cardiovascular adverse effects are challenging to predict, and the association with radiation exposure remains difficult to establish. Methodology This retrospective, observational
study was conducted using data from the National Inpatient Sample (NIS) database from 2016 to 2019. Adult patients with primary thoracic malignancies who underwent radiation therapy (RT) were defined using principal and secondary International Classification of Diseases, Tenth Revision codes. Other malignancies that can be treated with RT and all secondary malignancies were excluded from the primary comparison group. Cardiac outcomes were defined as the prevalence of congestive heart failure, coronary artery disease, cardiomyopathy, conduction disorders, pericardial diseases, and valvular heart diseases in the primary group. The multivariate logistic and the linear regression analyses were used to adjust for confounders. Results When compared to the general population, adults with thoracic malignancies exposed to RT had higher odds of developing chronic pericarditis (adjusted odds ratio (aOR) = 2, 95% confidence interval (CI) = 1.9-2.2, p < 0.001), acute pericarditis (aOR = 2.3, 95% CI = 1.9-2.9, p < 0.001), constrictive pericarditis (aOR = 2.8, 95% CI = 2.1-3.7, p < 0.001), conduction disorders (aOR = 1.3, 95% CI = 1.2-1.35, p < 0.001), coronary artery disease (aOR = 1.24, 95% CI = 1.2-1.27, p < 0.001), heart failure (aOR = 1.44, 95% CI = 1.4-1.5, p < 0.001), and valvular heart disease (aOR = 1.37, 95% CI = 1.3-1.4, p < 0.001). There was no difference in the odds of developing cardiac arrest (aOR = 1, 95% CI = 0.9-1.10, p = 0.6) or acute myocardial infarction (aOR = 1.1, 95% CI = 1-1.15, p < 0.001). When compared to adults with thoracic malignancies not exposed to RT, adults with thoracic malignancies who were exposed to RT had higher odds of developing acute myocardial infarction (aOR = 1.14, 95% CI = 1.1-1.18, p < 0.001), chronic pericarditis (aOR = 1.3, 95% CI = 1.2-1.3, p < 0.001), acute pericarditis (aOR = 1.6, 95% CI = 1.2-2.1, p < 0.001), constrictive pericarditis (aOR = 2.2, 95% CI = 1.5-3.2, p < 0.001), conduction disorders (aOR = 1.1, 95% CI = 1.08-1.13, p < 0.001), coronary artery disease (aOR = 1.14, 95% CI = 1.12-1.16, p < 0.001), heart failure (aOR = 1.2, 95% CI = 1.17-1.23, p < 0.001), and valvular heart disease (aOR = 1.3, 95% CI = 1.2-1.35, p < 0.001). The odds were similar between the two groups for developing cardiac arrest (aOR = 0.86, 95% CI = 0.8-0.98, p = 0.05). Conclusions Adults with thoracic malignancies who were treated with RT have higher odds of developing chronic pericarditis, acute pericarditis, constrictive pericarditis, conduction disorders, coronary artery disease, heart failure, and valvular heart disease while similar odds of developing cardiac arrest or acute myocardial infarction compared to the general adult population.
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