Evaluation of Coronary Artery Disease by Computed Tomography Angiography in Patients Treated for Childhood Hodgkin's Lymphoma

Abstract

PURPOSE To detect pathologies in coronary arteries by computed tomography angiography (CTA) in survivors of childhood Hodgkin's lymphoma who have been treated with radiotherapy and/or cardiotoxic agents. PATIENTS AND METHODS Patients with HL who have been in remission for at least 2 years after completion of therapy were included. CBC, lipid profile, urine analysis, brain natriuretic peptide, troponin-T, creatinine kinase-myocardial band, ECG, telecardiography, echocardiography, and CTA of the patients were performed. Cardiac vascular abnormalities were noted. Results A total of 119 patients were included in the study. In 19 patients (16%), we found coronary artery abnormalities. There was a significant difference between the patients who received mediastinal radiotherapy and those who did not (P = .02). By multivariate analysis, in patients receiving mediastinal radiotherapy the risk of developing a coronary artery abnormality was found to increase 6.8 times compared with patients who did not receive mediastinal radiotherapy (P = .009). Stent implantation was performed in a 28-year-old patient because of critical stenosis in right coronary. In two patients some irregularities were detected both in CTA and conventional angiography, and they remained in close follow-up. A 22-year-old patient whose CTA showed critical stenosis in his left anterior descending artery refused the conventional angiography. CONCLUSION To our knowledge, this is the first large study using CTA for detection of coronary abnormalities in patients treated for HL in pediatric age group. Coronary CTA is a minimally invasive tool for early diagnosis of coronary artery disease in patients who were treated with mediastinal radiotherapy and/or cardiotoxic chemotherapy.

Long-term risk of second malignancy and cardiovascular disease after Hodgkin lymphoma treatment

“…40 Prospective screening studies among HL survivors demonstrate that clinically significant cardiovascular abnormalities, like coronary artery stenosis, coronary artery calcifications, reduced left ventricular dimensions, VHD, and conduction defects, are very common, even in asymptomatic survivors. [45][46][47][48] Large cohort studies of HL survivors show a two-to sevenfold increased risk of cardiac death (mainly myocardial infarction [MI]), depending on the age of the patients (stronger risk increases for radiotherapy at younger ages), treatment regimens used, and followup time. 2,5,49,50 Furthermore, three-to sixfold increased SIRs of CHD, VHD, and HF are observed in patients treated for HL relative to the general population, also after long-term follow up.…”

Survivorship in Hodgkin Lymphoma

“…Classical CAD risk factors (hypertension, diabetes, cigarette smoking, and hyperlipidemia) continue to play a role in promoting atherosclerosis in HL survivors, necessitating optimal medical management. [63] At present, there have only been two prospective studies of cardiac screening in HL survivors. Heidenreich et al [64] reported an abnormal stress test (echocardiogram and/or radionucleotide myocardial perfusion scan) in 21% of asymptomatic HL survivors fifty percent of those with an abnormal functional study demonstrated an obstructive lesion at the time of definitive coronary angiography.…”

Assessment of cardiometabolic risk factors among adolescent survivors of childhood cancer

“…5,6 These events, together with an inactive lifestyle 9,10 and tobacco use, 11 are secondary to cancer treatment c o m p l i c a t i o n s ( a n t h r a c y c l i n e chemotherapy regimen, 7 thoracic and cranial radiotherapy). 8,9 Although cancer survivors have a higher risk for late cardiometabolic events, they are mostly sedentary, frequently use tobacco and alcohol, [12][13][14] even since adolescence, 15 and do not attend periodic medical check-ups. 16 In Argentina, the annual incidence of childhood cancer is 124/1 000 000 in children younger than 15 years old, with an average survival of 65%.…”