Functional testing, coronary artery calcifications, and outcomes in Hodgkin lymphoma survivors treated with chest radiation

Cardio-Oncology

Research

Sean M. Parks¹  Jon Hainer¹  Diana M. Lopez²  Sanjay Divakaran²  Marcelo F. Di Carli²  Ron Blankstein²  Anju Nohria³  Andrea K. Ng⁴ 

[1]Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Boston, MA, USA

[2]Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women’s Hospital, Boston, MA, USA

[3]Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Brigham & Women’s Hospital, 75 Francis Street, 02115, Boston, MA, USA

[4]Harvard Medical School, Boston, MA, USA

[5]Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Brigham & Women’s Hospital, 75 Francis Street, 02115, Boston, MA, USA

[6]Harvard Medical School, Boston, MA, USA

[7]Harvard Medical School, Boston, MA, USA

[8]Department of Radiation Oncology, Brigham and Women’s Hospital, Boston, MA, USA

关键词: Cancer survivorship;    Cardio-oncology;    Coronary artery calcifications;    Hodgkin lymphoma;    Primary prevention;    Stress testing;   

DOI  :  10.1186/s40959-023-00157-2

 received in 2022-06-19, accepted in 2023-01-09,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundConsensus guidelines recommend periodic screening for coronary artery disease (CAD) in Hodgkin lymphoma (HL) survivors treated with radiation therapy (RT) to the chest. However, the prognostic utility of screening strategies in this population remains unclear. We evaluated the association between functional testing, coronary artery calcifications (CAC), and guideline-based risk assessment and major adverse cardiovascular events (MACE) in HL survivors treated with RT.MethodsWe retrospectively studied HL survivors treated with RT who underwent functional testing between 2003 and 2020 and chest computed tomography (CT) within 12 months of each other at our center. CAC was assessed semi-quantitatively from CT images. Cardiovascular risk was estimated using the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease. Diagnostic test characteristics were calculated using major adverse cardiac events (MACE) during follow-up as the gold standard.ResultsThe study included 159 patients (median age at functional testing 48 years, median age at HL diagnosis 27 years, 62.9% female). Abnormal functional testing had the highest specificity (94.2% (95% CI 88.4%-97.6%)) and positive likelihood ratio (4.55 (95% CI 1.86–11.13)) while CAC had the highest sensitivity (63.2% (95% CI 46.0%-78.2%)) and lowest negative likelihood ratio (0.52 (95% CI 0.34–0.80)). Specificity for ACC/AHA risk assessment was also high (88.5% (95% CI 81.1%-93.7%)). Over 3.3 years of follow-up, abnormal functional testing (adjusted subdistribution hazard ratio (SHR) 5.10, 95% CI 2.41 – 10.78, p < 0.001) and CAC (adjusted SHR 3.58, 95% CI 1.35 – 9.47, p = 0.010) were both significantly associated with MACE.ConclusionsIn HL survivors treated with RT, both abnormal functional testing and ACC/AHA risk assessment had high specificity for subsequent MACE, but CAC had higher sensitivity. Further research is needed to inform CAD screening and primary prevention strategies in this population.

【 授权许可】

CC BY   
© The Author(s) 2023

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Fig. 2