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Published on: September 6, 2017
Framingham Risk Score Is an Ineffective Screening Strategy for Coronary Heart Disease in Long-Term Allogeneic
Natasha A Jain1, Marcus Y Chen2, Sujata Shanbhag2
1Hematology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
Insights
Coronary artery calcium (CAC) scoring is a superior screening tool for detecting early coronary heart disease (CHD) in allogeneic hematopoietic cell transplant (allo-HCT) survivors. This cardiac CT method significantly outperforms the Framingham Risk Score (FRS) in identifying at-risk individuals.
Area of Science:
- Cardiology
- Oncology
- Radiology
Background:
- Long-term survivors of allogeneic hematopoietic cell transplant (allo-HCT) face an increased risk of developing coronary heart disease (CHD).
- Early detection of CHD is crucial for managing cardiovascular complications in this vulnerable population.
Purpose of the Study:
- To evaluate the effectiveness of cardiac computed tomography (CT), including coronary CT angiography (CCTA) and coronary artery calcium (CAC) scoring, in screening asymptomatic allo-HCT survivors for CHD.
- To compare the diagnostic performance of CAC scoring and the Framingham Risk Score (FRS) in detecting early CHD in this cohort.
Main Methods:
- A prospective, cross-sectional study screened 79 asymptomatic allo-HCT survivors (median age 39 years, median follow-up 8 years).
- Participants underwent cardiac CT (CCTA and CAC scoring) and FRS assessment for CHD.
- Data on lesion characteristics, calcification, and valvular calcification were analyzed.
Main Results:
- Coronary heart disease (CHD) was detected in 42% of survivors.
- Coronary artery calcium (CAC) scoring demonstrated significantly higher sensitivity and negative predictive value for detecting early CHD compared to the Framingham Risk Score (FRS).
- Cardiac CT identified CHD in 34% of survivors classified as low-risk by FRS, highlighting FRS underestimation.
Conclusions:
- Coronary artery calcium (CAC) scoring, with or without coronary CT angiography (CCTA), is a safe, feasible, and sensitive screening method for CHD in allo-HCT survivors.
- The Framingham Risk Score (FRS) significantly underestimates the prevalence of CHD in allo-HCT survivors.
- Cardiac CT offers a valuable tool for early CHD detection in long-term allo-HCT survivors, enabling timely intervention.
Abstract:
Long-term allogeneic hematopoietic cell transplant (allo-HCT) survivors suffer an elevated risk of coronary heart disease (CHD). We conducted a prospective, nonrandomized, cross-sectional study to screen asymptomatic survivors at a single allo-HCT center using cardiac computed tomography (CT) involving coronary CT angiography (CCTA) and the coronary artery calcium (CAC) score. Seventy-nine subjects with a median age of 39 years at allo-HCT and a median follow-up interval of 8 years were evaluated for CHD by Framingham Risk Score (FRS) and cardiac CT. CHD was detected in 33 of 79 (42%) subjects; 91% of lesions were nonobstructive, 19.5% of were noncalcified and 30% had associated valvular calcification. Overall, CAC was significantly superior to FRS in detecting early CHD in allo-HCT survivors [∆C = 0.25; P < 0.0001]. While both FRS and CAC were highly, >95% specific, FRS had a sensitivity, positive and negative predictive values of only 28% (95% CI, 14%-47%), 90% (95% CI, 55%-100%) and 60% (95% CI, 47%-73%), respectively. In contrast, the sensitivity, positive and negative predictive values of CAC were 78% (95% CI, 60%-91%), 96% (95% CI, 80%-100%) and 83% (95% CI, 69%-93%), respectively. Significantly, cardiac CT detected CHD in 23 of the 68 (34%) survivors deemed to have a low Framingham risk. Radiation exposure during cardiac CT was negligible, and there were no adverse events. In conclusion, CAC score with or without CCTA is a safe, feasible and sensitive screening technique for CHD. The FRS greatly underestimates CHD in allo-HCT survivors.
