CT angiography sheds new light on Hodgkin's lymphoma

Using coronary CT angiography (CTA), Dutch researchers have found that Hodgkin's lymphoma survivors have more severe coronary artery disease (CAD) 20 years after chest irradiation

The research, presented at the International Conference on Nuclear Cardiology and Cardiac CT (ICNC) 2017, assessed the extent, severity, and location of coronary artery disease in Hodgkin's lymphoma survivors who had received chest irradiation. The study included 79 patients who had been free of Hodgkin's lymphoma for at least 10 years and received mediastinal irradiation 20 years ago, plus 273 controls without Hodgkin's lymphoma or irradiation.

"Patients with Hodgkin's lymphoma receive high-dose mediastinal irradiation at a young age as part of their treatment," said Dr. Alexander van Rosendael, from Leiden University Medical Centre in the Netherlands. "There is an ongoing debate about whether to screen patients who get chest irradiation for coronary artery disease."

Patients and controls were matched in a one-to-three fashion by age, gender, diabetes, hypertension, hypercholesterolemia, family history of coronary artery disease, and smoking status. Patients were 45 years old on average, and the presence of cardiovascular risk factors was low overall. Just 42% of patients had no atherosclerosis on coronary CTA compared with 64% of the controls.

Hodgkin's patients had significantly more multivessel CAD: 10% had two-vessel disease and 24% had three-vessel disease compared with 6% and 9% of the controls, respectively. The segment involvement score and the segment stenosis score were significantly higher for Hodgkin's patients.

Compared with the controls, Hodgkin's patients had significantly more coronary plaques in the left main (17% versus 6%), proximal left anterior descending (30% versus 16%), proximal right coronary artery (25% versus 10%), and proximal left circumflex (14% versus 6%) but not in nonproximal coronary segments. Patients had a fourfold risk of proximal plaque and a threefold risk of proximal obstructive stenosis compared with the controls.

Irradiated patients had all the features of high-risk CAD, including high stenosis severity, proximal location, and extensive disease. This may explain why Hodgkin's patients have such poor cardiovascular outcomes when they get older, according to the study authors.

The finding of more, and more severe, CAD in irradiated patients supports the argument for screening, they noted.

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