Coronary artery disease detected by coronary computed tomography angiography in adult survivors of childhood Hodgkin lymphoma. Issue 22 (16th July 2014)

• Record Type: Journal Article
• Authors: Mulrooney, Daniel A.; Nunnery, Sara E.; Armstrong, Gregory T.; Ness, Kirsten K.; Srivastava, Deokumar; Donovan, F. Daniel; Kurt, Beth A.; Metzger, Monika L.; Krasin, Matthew J.; Joshi, Vijaya; Durand, Jean‐Bernard; Robison, Leslie L.; Hudson, Melissa M.; Flamm, Scott D.
• Is Part Of: Cancer. Volume 120:Issue 22(2014)
• Page Start: 3536
• Page End: 3544
• Publication Date: 2014-07-16
• Subjects: cardiovascular -- Hodgkin lymphoma -- computed tomography angiography -- coronary artery disease -- radiotherapy; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.28925
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : BACKGROUND: Survivors of Hodgkin lymphoma (HL) have significant cardiovascular risk and require long‐term surveillance. The current study assessed the prevalence of coronary artery disease (CAD) by coronary computed tomography angiography (CCTA) in adult survivors of childhood HL. METHODS: Thirty‐one survivors of HL, 13 of whom (42%) were treated with radiotherapy (RT) only and 18 of whom (58%) were treated with multimodal therapy, underwent CCTA, echocardiography, electrocardiography (ECG), and treadmill stress testing. Obstructive CAD was defined as ≥50% occlusion of the left main or ≥70% occlusion of the left anterior descending, left circumflex, or right coronary arteries on CCTA. Echocardiograms with resting wall motion abnormalities or an ejection fraction <50%; ECGs with Q waves, ST abnormalities without Q waves, or T‐wave abnormalities without Q waves; and a J‐point depression of ≥1 mm with a horizontal or downsloping ST segment on stress testing were considered abnormal. RESULTS: The prevalence of disease in participants (median age, 40 years [range, 26 years‐55 years]; median time from cancer diagnosis, 24 years [range, 17 years‐39 years]) was 39%, with 39 plaques detected among 12 survivors. Three participants (10%) treated with RT only had 4 obstructive lesions; 9 patients (29%; 5 of whom were treated with RT only and 4 of whom were treated with multimodal therapy) had nonobstructive lesions. Approximately 15% of lesions involved the left main, 21% involved the proximal left anterior descending, 18% involved the proximal right coronary, and 13% involved the proximal left circumflex arteries. Of the 12 participants found to have CAD by CCTA, 7 had a positive ECG, 1 had a positive echocardiogram, and 1 had a positive stress test. CONCLUSIONS: CCTA identified CAD in a substantial percentage of survivors of HL and may be an effective screening modality for this population. Cancer 2014;120:3536–3544. © 2014 American Cancer Society . Abstract : In the current study, coronary computed tomography angiography identified a significant percentage of survivors of childhood Hodgkin lymphoma with subclinical coronary artery disease. This noninvasive imaging technique may help clinicians to identify those patients who might benefit from lifestyle and/or medication interventions and those for whom lower levels of monitoring may be appropriate.