{"doi":"10.1016/j.ijrobp.2021.03.005","title":"Mean Heart Dose Is an Inadequate Surrogate for Left Anterior Descending Coronary Artery Dose and the Risk of Major Adverse Cardiac Events in Lung Cancer Radiation Therapy","abstract":null,"journal":"International Journal of Radiation Oncology*Biology*Physics","year":2021,"id":641308,"datarank":0.6476232170304466,"base_score":4.31748811353631,"endowment":4.31748811353631,"self_citation_contribution":0.6476232170304466,"citation_network_contribution":0.0,"self_endowment_contribution":0.6476232170304466,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":74,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":229099,"name":"Danielle S. Bitterman","orcid":"0000-0003-0345-2232","position":1,"is_corresponding":false},{"id":621013,"name":"Tafadzwa L. Chaunzwa","orcid":"0000-0001-7216-159X","position":2,"is_corresponding":false},{"id":1667285,"name":"David E. Kozono","orcid":null,"position":3,"is_corresponding":false},{"id":622614,"name":"Elizabeth H. Baldini","orcid":null,"position":4,"is_corresponding":false},{"id":37161,"name":"Hugo J.W.L. Aerts","orcid":"0000-0002-2122-2003","position":5,"is_corresponding":false},{"id":1667288,"name":"Balaji K. Tamarappoo","orcid":null,"position":6,"is_corresponding":false},{"id":235806,"name":"Udo Hoffmann","orcid":"0000-0001-5514-769X","position":7,"is_corresponding":false},{"id":232168,"name":"Anju Nohria","orcid":"0000-0002-7113-1118","position":8,"is_corresponding":false},{"id":16655,"name":"Raymond H. Mak","orcid":"0000-0002-8754-0565","position":9,"is_corresponding":false},{"id":1400995,"name":"Katelyn M. Atkins","orcid":"0000-0002-3165-4803","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Mean Heart Dose Is an Inadequate Surrogate for Left Anterior Descending Coronary Artery Dose and the Risk of Major Adverse Cardiac Events in Lung Cancer Radiation Therapy","abstract":"Purpose Mean heart dose (MHD) over 10 Gy and left anterior descending (LAD) coronary artery volume (V) receiving 15 Gy (V15Gy) greater than 10% can significantly increase the risk of major adverse cardiac events (MACE) in patients with non-small cell lung cancer (NSCLC). We sought to characterize the discordance between MHD and LAD dose and the association of this classification on the risk of MACE after radiation therapy. Methods and Materials The coefficient of determination for MHD and LAD V15Gy was calculated in this retrospective analysis of 701 patients with locally advanced NSCLC treated with radiation therapy. Four groups were defined on the basis of high or low MHD (≥10 Gy vs <10 Gy) and LAD V15Gy (≥10% vs <10%). MACE (unstable angina, heart failure, myocardial infarction, coronary revascularization, and cardiac death) cumulative incidence was estimated, and Fine and Gray regressions were performed. Results The proportion of variance in LAD V15Gy predictable from MHD was only 54.5% (R 2 = 0.545). There was discordance (where MHD was high [≥10 Gy] and LAD low [V15Gy < 10%], or vice versa) in 23.1% of patients (n = 162). Two-year MACE estimates were 4.2% (MHD high /LAD low ), 7.6% (MHD high /LAD high ), 1.8% (MHD low /LAD low ), and 13.0% (MHD low /LAD high ). Adjusting for pre-existing coronary heart disease and other prognostic factors, MHD high /LAD low (subdistribution hazard ratio [SHR], 0.34; 95% CI, 0.13-0.93; P = .036) and MHD low /LAD low (SHR, 0.24; 95% CI, 0.10-0.53; P < . 001) were associated with a significantly reduced risk of MACE. Conclusions MHD is insufficient to predict LAD V15Gy with confidence. When MHD and LAD V15Gy dose exposure is discordant, isolated low LAD V15Gy significantly reduces the risk of MACE in patients with locally advanced NSCLC after radiation therapy, suggesting that the validity of whole heart metrics for optimally predicting cardiac events should be reassessed.","is_dataset_classified":null,"base_score":4.31748811353631,"endowment":4.31748811353631,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"33713743","pmcid":null,"openalex_id":"https://openalex.org/W3133970023","authors":[],"funders":[],"total_grants":0,"fwci":7.4514,"citation_percentile":0.98187368,"influential_citations":0,"citation_trend":[{"year":2021,"count":1},{"year":2022,"count":22},{"year":2023,"count":12},{"year":2024,"count":16},{"year":2025,"count":12},{"year":2026,"count":11}],"oa_status":"hybrid","license":"cc-by-nc-nd","oa_locations":[{"url":"https://doi.org/10.1016/j.ijrobp.2021.03.005","host_type":"journal"},{"url":"https://doi.org/10.1016/j.ijrobp.2021.03.005","host_type":"publisher"},{"url":"https://api.elsevier.com/content/article/PII:S0360301621002455?httpAccept=text/xml","host_type":"publisher"},{"url":"https://api.elsevier.com/content/article/PII:S0360301621002455?httpAccept=text/plain","host_type":"publisher"},{"url":"https://pubmed.ncbi.nlm.nih.gov/33713743","host_type":"repository"},{"url":"https://hdl.handle.net/1805/44704","host_type":"repository"},{"url":"http://www.redjournal.org/article/S0360301621002455/pdf","host_type":"Unpaywall"}],"fields_of_study":["Chemotherapy-induced cardiotoxicity and mitigation","Cardiac Imaging and Diagnostics","Radiation Dose and Imaging"],"mesh_terms":["Aged","Angina Pectoris","Carcinoma, Non-Small-Cell Lung","Coronary Vessels","Death","Female","Heart","Heart Diseases","Heart Failure","Humans","Lung Neoplasms","Male","Middle Aged","Myocardial Infarction","Myocardial Revascularization","Radiation Dosage","Retrospective Studies","Incidence","Cardiotoxicity"],"keywords":["Cardiology","Myocardial infarction","Internal medicine","Medicine","Mace","Coronary artery disease","Conventional PCI"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Good health and well-being"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-07T17:11:54.296427Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}