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Functional testing, coronary artery calcifications, and outcomes in Hodgkin lymphoma survivors treated with chest

Sanjay Divakaran1,2,3, Diana M Lopez1,2,3, Sean M Parks1

  • 1Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Boston, MA, USA.

Cardio-Oncology (London, England)
|January 20, 2023
PubMed

Insights

Screening Hodgkin lymphoma (HL) survivors treated with chest radiation therapy (RT) for coronary artery disease (CAD) is recommended. Both functional testing and coronary artery calcifications (CAC) predict major adverse cardiac events (MACE).

Area of Science:

  • Cardiology
  • Oncology
  • Radiology

Background:

  • Consensus guidelines advocate for regular coronary artery disease (CAD) screening in Hodgkin lymphoma (HL) survivors who received chest radiation therapy (RT).
  • The prognostic value of current screening methods for cardiovascular events in this high-risk group is not well-established.
  • This study investigates the predictive utility of functional testing, coronary artery calcifications (CAC), and guideline-based risk assessment for major adverse cardiovascular events (MACE) in HL survivors.

Purpose of the Study:

  • To assess the association between different screening strategies and the occurrence of MACE in Hodgkin lymphoma survivors treated with radiation therapy.
  • To determine the diagnostic test characteristics of functional testing, CAC, and ACC/AHA risk assessment in predicting MACE.
  • To provide data to inform optimal screening and primary prevention strategies for cardiovascular disease in this population.

Main Methods:

  • Retrospective analysis of 159 Hodgkin lymphoma survivors treated with RT, who underwent both functional testing and chest CT within a 12-month period.
  • Coronary artery calcifications (CAC) were semi-quantitatively assessed from CT images.
  • Cardiovascular risk was estimated using the 2019 ACC/AHA Primary Prevention Guidelines. Diagnostic test characteristics were evaluated against MACE during follow-up.

Main Results:

  • Abnormal functional testing demonstrated the highest specificity (94.2%) and positive likelihood ratio (4.55) for MACE.
  • Coronary artery calcifications (CAC) exhibited the highest sensitivity (63.2%) and lowest negative likelihood ratio (0.52).
  • Both abnormal functional testing (aSHR 5.10) and CAC (aSHR 3.58) were significantly associated with MACE over a median follow-up of 3.3 years.

Conclusions:

  • In Hodgkin lymphoma survivors treated with RT, abnormal functional testing and ACC/AHA risk assessment show high specificity for predicting future MACE.
  • Coronary artery calcifications (CAC) offer higher sensitivity for MACE detection in this cohort.
  • Further research is essential to refine CAD screening protocols and primary prevention strategies for this patient population.
Abstract

Keywords:
Cancer survivorshipCardio-oncologyCoronary artery calcificationsHodgkin lymphomaPrimary preventionStress testing

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