Radiation and the heart: systematic review of dosimetry and cardiac endpoints.

INTRODUCTION: Recent trials in radiotherapy have associated heart dose and survival, inadequately explained by the existing literature for radiation-related late cardiac effects.  Authors aimed to review the recent literature on cardiac dosimetry and survival/cardiac endpoints. Areas covered: Systematic review of the literature in the past 10 years (2008-2017) was performed to identify manuscripts reporting both cardiac dosimetry and survival/cardiac endpoints.  Authors identified 64 manuscripts for inclusion, covering pediatrics, breast cancer, lung cancer, gastrointestinal diseases (primarily esophageal cancer), and adult lymphoma. Expert commentary: In the first years after radiotherapy, high doses (>40 Gy) to small volumes of the heart are associated with decreased survival from an unknown cause.  In the long-term, mean heart dose is associated with a small increased absolute risk of cardiac death.  For coronary disease, relative risk increases roughly 10% per Gy mean heart dose, augmented by age and cardiac risk factors.  For valvular disease and heart failure, doses >15 Gy substantially increase risk, augmented by anthracyclines.  Arrhythmias after radiotherapy are poorly described but may account for the association between upper heart dose and survival.  Symptomatic pericardial effusion typically occurs with doses >40 Gy.  Close follow-up and mitigation of cardiovascular risk factors are necessary after thoracic radiotherapy.

Greater Occipital Nerve Block for Acute Treatment of Migraine Headache: A Large Retrospective Cohort Study.

INTRODUCTION: Greater occipital nerve (GON) blocks are frequently used to treat migraine headaches, although a paucity of supporting clinical evidence exists. The objective of this study was to assess the efficacy of GON block in acute treatment of migraine headache, with a focus on pain relief. METHODS: This retrospective cohort study was undertaken between January 2009 and August 2014 and included patients who underwent at least 1 GON block and attended at least 1 follow-up appointment. Change in the 11-point numeric pain rating scale (NPRS) was used to assess the response to GON block. Response was defined as "minimal" (<30% NPRS point reduction), "moderate" (31-50% NPRS point reduction), or "significant" (>50% NPRS point reduction). RESULTS: A total of 562 patients met inclusion criteria; 423 were women (75%). Mean age was 58.6 ± 16.7 years. Of these 562, 459 patients (82%) rated their response to GON block as moderate or significant. No statistically significant relationship existed between previous treatment regimens and response to GON block. GON block was equally effective across the different age and sex groups. CONCLUSIONS: Greater occipital block seems to be an effective option for acute management of migraine headache, with promising reductions in pain scores.

Prevalence and Prognostic Significance of Nonsustained Ventricular Tachycardia in Patients With a Left Ventricular Ejection Fraction from 35% to 50.

The risk of life-threatening ventricular arrhythmias in patients with mild-to-moderately reduced left ventricular ejection fraction (LVEF) is unknown. This retrospective case-control study aims to identify the prevalence, risk factors, and outcomes associated with the development of nonsustained ventricular tachycardia (NSVT) as documented on permanent pacemakers or implantable loop recorders in tertiary care center patients with an LVEF of 35% to 50%. Data pertaining to patient demographics, previous medical history, heart failure functional class, echocardiographic parameters, and survival were compared between the groups. Of the 326 patients with an LVEF within the target range, 90 patients (27.6%) had NSVT recorded on their device and 236 patients (72.4%) did not. Compared with patients without NSVT, patients with NSVT had a higher body mass index (28.4 kg/m2 vs 26.8 kg/m2, p = 0.02), more ischemic heart disease (57.8% vs 32.8%, p < 0.0001), higher left atrial volume index (45.8 ml/m2 vs 42.0 ml/m2, p = 0.04), and lower use of antiarrhythmic medications (4.4% vs 11.9%, p = 0.04). The presence of NSVT and the duration of NSVT had no relation to survival, supporting the notion that NSVT is a benign finding in patients with an LVEF of 35% to 50%.