Noninvasive tool identified high coronary artery disease burden in childhood cancer survivors
Coronary CT angiography identified coronary artery disease in a high percentage of adult survivors of childhood Hodgkin’s lymphoma, according to study results.
“Coronary computed tomography angiography may offer an effective noninvasive tool for the management of at-risk cancer survivors, permitting the identification of those who might benefit from lifestyle and/or medication interventions and those for whom lower levels of monitoring may be appropriate,” Daniel A. Mulrooney, MD, MS, of the division of cancer survivorship in the department of oncology at St. Jude Children’s Research Hospital, and colleagues wrote.
Daniel A. Mulrooney
Mulrooney and colleagues used coronary CT angiography (CCTA) to assess the prevalence of coronary artery disease in 31 adult survivors of childhood Hodgkin’s lymphoma. The median age of survivors was 40 years, and the median time from cancer diagnosis was 24 years. Thirteen (42%) of the survivors were treated with radiotherapy only and 18 (58%) underwent multimodal therapy.
All survivors underwent CCTA, echocardiography, electrocardiography and treadmill stress tests.
Researchers defined obstructive coronary artery disease as ≥50% occlusion of the left main or ≥70% occlusion of the left anterior descending, left circumflex or right coronary arteries.
According to study results, the prevalence of coronary artery disease was 39%, with 39 plaques identified among 12 adults. Of these, seven had a positive echocardiography, one had a positive echocardiogram and one had a positive stress test.
Researchers identified a combined four obstructive lesions in three survivors, all of whom were treated with radiotherapy only. Researchers identified a combined 35 nonobstructive lesions in nine patients, five of whom underwent radiotherapy only and four of whom underwent multimodal therapy.
Overall, 13% of lesions involved the proximal left circumflex arteries, 15% involved the left main artery, 18% involved the proximal right coronary artery and 21% involved the proximal left anterior descending artery.
“The lesions clustered in a proximal distribution, thereby increasing the risk of larger myocardial infarctions and coronary death,” Mulrooney and colleagues wrote. “Given the rarity of ischemic heart disease among young people, few of these asymptomatic survivors of [Hodgkin’s] lymphoma would typically have been screened for this condition.”
Disclosure: The study was supported by Cancer Center Support (CORE) Grant CA21765 to St. Jude Children’s Research Hospital and the American Lebanese Syrian Associated Charities (ALSAC). One researcher reports grant funding from the NIH.