Chest irradiation confers elevated risk for CAD in Hodgkin lymphoma
Compared with matched controls, mediastinal irradiated Hodgkin lymphoma survivors have greater prevalence and severity of CAD, according to findings presented at the International Conference on Nuclear Cardiology and Cardiac CT.
“Patients with Hodgkin lymphoma receive high-dose mediastinal irradiation at a young age as part of their treatment,” Alexander R. van Rosendael, MD, from the department of cardiology at Leiden University Medical Centre in the Netherlands, said in a press release. “There is an ongoing debate about whether to screen patients who got chest irradiation for [CAD].”
The researchers compared 79 patients with Hodgkin lymphoma who received high-dose mediastinal irradiation with 237 controls matched for age, sex, diabetes, hypertension, hypercholesterolemia, CAD family history and smoking status for differences in presence, extent, severity, composition and location of CAD. All participants underwent coronary CTA.
Among participants, mean age was 45 years, 2% had diabetes, 9% had hypertension, 8% had hypercholesterolemia and 3% were current smokers.
Forty-two percent of those with Hodgkin lymphoma had no atherosclerosis on coronary CTA, compared with 64% of controls (P < .001), according to the researchers.
Two-vessel disease (10% vs. 6%) and three-vessel disease (24% vs. 9%) were more common on Hodgkin lymphoma survivors than in controls (P = .001), van Rosendael and colleagues found.
The segment involvement score (P < .001), which measures overall plaque distribution, and segment stenosis score (P = .034), which measures plaque extent and severity, were both higher in the lymphoma group than in the control group, according to the researchers.
Compared with controls, the lymphoma group had more coronary plaques in the left main artery (17% vs. 6%; P = .004), the proximal left anterior descending artery (30% vs. 16%; P = .004), the proximal right coronary artery (25% vs. 10%; P < .001) and the proximal left circumflex artery (14% vs. 6%; P = .022), but there was no difference between the groups in coronary plaques in nonproximal segments.
Those with Hodgkin lymphoma were at increased risk for any proximal plaque (OR = 4.1; 95% CI, 2.4-6.9) and any proximal obstructive stenosis (OR = 2.9; 95% CI, 1.1-7.5) compared with controls, according to van Rosendael and colleagues.
“Hodgkin patients who have chest radiation have much more CAD than people of the same age who did not have irradiation,” van Rosendael said in the release. “The CAD occurred at a young age ... and was probably caused by the irradiation. The CTA was done about 20 years after chest irradiation, so there was time for CAD to develop. What was remarkable was that irradiated patients had all the features of high-risk CAD, including high stenosis severity, proximal location and extensive disease. We know that the proximal location of the disease is much riskier and this may explain why Hodgkin patients have such poor [CV] outcomes when they get older.”
He said in the release that patients with Hodgkin lymphoma “should be screened at regular intervals after irradiation so that CAD can be spotted early, and early treatment can be initiated.” – by Erik Swain
van Rosendael AR, et al. Abstract P118. Presented at: International Conference on Nuclear Cardiology and Cardiac CT; May 7-9, 2017; Vienna.
Disclosure : van Rosendael reports being supported by a research grant from the Netherlands Heart Institute.