Table 3.

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

1	Annual follow-up with a cardiologist or cardio-oncologist for history and physical examination
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