Virginie Beauséjour Ladouceur1, Patrick R Lawler1, Michelle Gurvitz1, Louise Pilote1, Mark J Eisenberg1, Raluca Ionescu-Ittu1, Liming Guo1, Ariane J Marelli2. 1. From Department of Cardiology, Children's Hospital Boston, Harvard Medical School, MA (V.B.L., M.G.); Department of Pediatrics, Montreal Children's Hospital, McGill University, QC, Canada (V.B.L.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.R.L.); Department of Medicine, McGill University Health Center, Montreal, QC, Canada (P.R.L., L.P.); and Division of Cardiology, Jewish General Hospital (M.J.E.) and McGill Adult Unit for Congenital Heart Disease Excellence (R.I.-I., L.G., A.J.M.), McGill University, Montreal, QC, Canada. 2. From Department of Cardiology, Children's Hospital Boston, Harvard Medical School, MA (V.B.L., M.G.); Department of Pediatrics, Montreal Children's Hospital, McGill University, QC, Canada (V.B.L.); Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (P.R.L.); Department of Medicine, McGill University Health Center, Montreal, QC, Canada (P.R.L., L.P.); and Division of Cardiology, Jewish General Hospital (M.J.E.) and McGill Adult Unit for Congenital Heart Disease Excellence (R.I.-I., L.G., A.J.M.), McGill University, Montreal, QC, Canada. ariane.marelli@mcgill.ca.
Abstract
BACKGROUND: The burden of low-dose ionizing radiation (LDIR) exposure from medical procedures among individuals with congenital heart disease (CHD) is unknown. In this longitudinal population-based study, we sought to determine exposure to LDIR-related cardiac imaging and therapeutic procedures in children and adults with CHD. METHODS AND RESULTS: In an analysis of the Quebec CHD database, exposure to the following LDIR-related cardiac procedures was recorded: catheter-based diagnostic procedures, structural heart interventions, coronary interventions, computed tomography scans of the chest, nuclear procedures, and pacemaker/implantable cardioverter-defibrillator insertion and repair. From 1990 to 2005, there were 16 253 LDIR-exposed patients with CHD with 317 988 patient-years of available follow-up. The total number of LDIR-related procedures increased from 18.5 to 51.9 per 1000 CHD patients per year (P<0.0001). This increase was attributable to increases in rates per 1000 CHD patients in diagnostic cardiac catheterizations (11.7 to 13.7 per 1000), structural heart interventions (1.0 to 5.2 per 1000), coronary interventions (1.0 to 2.4 per 1000), pacemaker/implantable cardioverter-defibrillator insertions (1.6 to 4.4 per 1000), nuclear procedures (4.2 to 13.8 per 1000), and computed tomography scans of the chest (2.5 to 12.3 per 1000). Over time, among children with CHD, the median age at first LDIR procedure decreased from 5.0 years to 9.6 months. Severity of CHD significantly predicted extent of exposure. CONCLUSIONS: From 1990 to 2005, patients with CHD were exposed to increasing numbers of LDIR-emitting cardiac procedures. This exposure occurred at progressively younger ages. These findings provide an important perspective on longitudinal LDIR exposure in this at-risk population.
BACKGROUND: The burden of low-dose ionizing radiation (LDIR) exposure from medical procedures among individuals with congenital heart disease (CHD) is unknown. In this longitudinal population-based study, we sought to determine exposure to LDIR-related cardiac imaging and therapeutic procedures in children and adults with CHD. METHODS AND RESULTS: In an analysis of the Quebec CHD database, exposure to the following LDIR-related cardiac procedures was recorded: catheter-based diagnostic procedures, structural heart interventions, coronary interventions, computed tomography scans of the chest, nuclear procedures, and pacemaker/implantable cardioverter-defibrillator insertion and repair. From 1990 to 2005, there were 16 253 LDIR-exposed patients with CHD with 317 988 patient-years of available follow-up. The total number of LDIR-related procedures increased from 18.5 to 51.9 per 1000 CHD patients per year (P<0.0001). This increase was attributable to increases in rates per 1000 CHD patients in diagnostic cardiac catheterizations (11.7 to 13.7 per 1000), structural heart interventions (1.0 to 5.2 per 1000), coronary interventions (1.0 to 2.4 per 1000), pacemaker/implantable cardioverter-defibrillator insertions (1.6 to 4.4 per 1000), nuclear procedures (4.2 to 13.8 per 1000), and computed tomography scans of the chest (2.5 to 12.3 per 1000). Over time, among children with CHD, the median age at first LDIR procedure decreased from 5.0 years to 9.6 months. Severity of CHD significantly predicted extent of exposure. CONCLUSIONS: From 1990 to 2005, patients with CHD were exposed to increasing numbers of LDIR-emitting cardiac procedures. This exposure occurred at progressively younger ages. These findings provide an important perspective on longitudinal LDIR exposure in this at-risk population.
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