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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Relation between Coronary Artery Calcium Score and Cardiovascular Events in Hodgkin Lymphoma Survivors: A
Elissa A S Polomski1, Julius C Heemelaar1, Michiel A de Graaf1
1Department of Cardiology, Heart Lung Center, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands.
Insights
Hodgkin lymphoma (HL) survivors treated with thoracic radiotherapy show a significantly higher prevalence of coronary artery calcium score (CACS) and increased cardiovascular event risk compared to controls. Long-term screening for coronary artery disease (CAD) is crucial for these patients.
Area of Science:
- Cardiology
- Oncology
- Radiotherapy
Background:
- Thoracic radiotherapy is a cornerstone of Hodgkin lymphoma (HL) treatment but increases cardiovascular event risk.
- HL is often diagnosed in young individuals, necessitating long-term follow-up and coronary artery disease (CAD) screening.
Purpose of the Study:
- To evaluate the presence of coronary artery calcium score (CACS) in HL patients treated with thoracic radiotherapy.
- To compare CACS and cardiovascular events in HL survivors versus a non-cancer control group.
Main Methods:
- 97 HL patients treated with thoracic irradiation and evaluated for asymptomatic CAD via coronary computed tomography angiography >10 years post-treatment were included.
- HL patients were matched to 97 non-cancer controls based on gender, age, cardiovascular risk factors, and statin use.
Main Results:
- Elevated CACS (>0) was found in 50.5% of HL survivors versus 30.9% of controls (OR 2.28, p=0.006).
- Prevalence of CACS >90th percentile was significantly higher in HL survivors (17.1% vs. 4.6%, p=0.009).
- Non-obstructive coronary artery stenosis and cardiovascular events were more frequent in HL survivors.
Conclusions:
- HL survivors exhibit a higher prevalence of elevated CACS after thoracic radiotherapy compared to matched non-cancer controls.
- These survivors face an increased risk of cardiovascular events, underscoring the need for vigilant screening.
Background:
Thoracic radiotherapy is one of the corner stones of HL treatment, but it is associated with increased risk of cardiovascular events. As HL is often diagnosed at a young age, long-term follow-up including screening for coronary artery disease (CAD) is recommended.
Objectives:
This study aims to evaluate the presence of coronary artery calcium score (CACS) in relation to cardiovascular events in HL patients treated with thoracic radiotherapy compared to a non-cancer control group.
Methods:
Consecutive HL patients who underwent evaluation for asymptomatic CAD with coronary computed tomography angiography > 10 years after thoracic irradiation were included. The study population consisted of 97 HL patients matched to 97 non-cancer patients on gender, age, cardiovascular risk factors, and statin use.
Results:
Mean age during CT scan in the HL population was 45.5 ± 9.9 and in the non-cancer population 45.5 ± 10.3 years. CACS was elevated (defined as >0) in 49 (50.5%) HL patients and 30 (30.9%) control patients. HL survivors had an odds ratio of 2.28 [95% CI: 1.22-4.28] for having a CACS > 0 compared to the matched population (p = 0.006). Prevalence of CACS > 90th percentile differed significantly: 17.1% in HL survivors vs. 4.6% in the matched population (p = 0.009). Non-obstructive coronary artery stenosis was more prevalent in the HL population than in the control population (45.7% vs. 28.4%, respectively, p = 0.01). During follow-up of 8.5 [5.3; 9.9] years, nine HL patients experienced an event including two patients with a CACS of zero. No events occurred in the control population.
Conclusion:
In a matched study population, HL survivors have a higher prevalence of a CACS > 0 and an increased risk of cardiovascular events after thoracic irradiation compared to a matched non-cancer control group.
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