Coronary artery disease detected by coronary computed tomography angiography in adult survivors of childhood Hodgkin lymphoma

Daniel A. Mulrooney, Sara E. Nunnery, Gregory Armstrong, Kirsten K. Ness, Deokumar Srivastava, F. Daniel Donovan, Beth A. Kurt, Monika L. Metzger, Matthew J. Krasin, Vijaya Joshi, Jean Bernard Durand, Leslie L. Robison, Melissa M. Hudson, Scott D. Flamm

Research output: Contribution to journalArticle

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Abstract

BACKGROUND: Survivors of Hodgkin lymphoma (HL) have significant cardiovascular risk and require long-term surveillance. The current study assessed the prevalence of coronary artery disease (CAD) by coronary computed tomography angiography (CCTA) in adult survivors of childhood HL. METHODS: Thirty-one survivors of HL, 13 of whom (42%) were treated with radiotherapy (RT) only and 18 of whom (58%) were treated with multimodal therapy, underwent CCTA, echocardiography, electrocardiography (ECG), and treadmill stress testing. Obstructive CAD was defined as ≥50% occlusion of the left main or ≥70% occlusion of the left anterior descending, left circumflex, or right coronary arteries on CCTA. Echocardiograms with resting wall motion abnormalities or an ejection fraction <50%; ECGs with Q waves, ST abnormalities without Q waves, or T-wave abnormalities without Q waves; and a J-point depression of ≥1 mm with a horizontal or downsloping ST segment on stress testing were considered abnormal. RESULTS: The prevalence of disease in participants (median age, 40 years [range, 26 years-55 years]; median time from cancer diagnosis, 24 years [range, 17 years-39 years]) was 39%, with 39 plaques detected among 12 survivors. Three participants (10%) treated with RT only had 4 obstructive lesions; 9 patients (29%; 5 of whom were treated with RT only and 4 of whom were treated with multimodal therapy) had nonobstructive lesions. Approximately 15% of lesions involved the left main, 21% involved the proximal left anterior descending, 18% involved the proximal right coronary, and 13% involved the proximal left circumflex arteries. Of the 12 participants found to have CAD by CCTA, 7 had a positive ECG, 1 had a positive echocardiogram, and 1 had a positive stress test. CONCLUSIONS: CCTA identified CAD in a substantial percentage of survivors of HL and may be an effective screening modality for this population. Cancer 2014;120:3536–3544.

Original languageEnglish (US)
Pages (from-to)3536-3544
Number of pages9
JournalCancer
Volume120
Issue number22
DOIs
StatePublished - Nov 1 2014

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Hodgkin Disease
Survivors
Coronary Artery Disease
Electrocardiography
Radiotherapy
Exercise Test
Echocardiography
Neoplasms
Coronary Vessels
Arteries
Cross-Sectional Studies
Computed Tomography Angiography
Therapeutics
Population

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Mulrooney, D. A., Nunnery, S. E., Armstrong, G., Ness, K. K., Srivastava, D., Donovan, F. D., ... Flamm, S. D. (2014). Coronary artery disease detected by coronary computed tomography angiography in adult survivors of childhood Hodgkin lymphoma. Cancer, 120(22), 3536-3544. https://doi.org/10.1002/cncr.28925

Coronary artery disease detected by coronary computed tomography angiography in adult survivors of childhood Hodgkin lymphoma. / Mulrooney, Daniel A.; Nunnery, Sara E.; Armstrong, Gregory; Ness, Kirsten K.; Srivastava, Deokumar; Donovan, F. Daniel; Kurt, Beth A.; Metzger, Monika L.; Krasin, Matthew J.; Joshi, Vijaya; Durand, Jean Bernard; Robison, Leslie L.; Hudson, Melissa M.; Flamm, Scott D.

In: Cancer, Vol. 120, No. 22, 01.11.2014, p. 3536-3544.

Research output: Contribution to journalArticle

Mulrooney, DA, Nunnery, SE, Armstrong, G, Ness, KK, Srivastava, D, Donovan, FD, Kurt, BA, Metzger, ML, Krasin, MJ, Joshi, V, Durand, JB, Robison, LL, Hudson, MM & Flamm, SD 2014, 'Coronary artery disease detected by coronary computed tomography angiography in adult survivors of childhood Hodgkin lymphoma', Cancer, vol. 120, no. 22, pp. 3536-3544. https://doi.org/10.1002/cncr.28925
Mulrooney, Daniel A. ; Nunnery, Sara E. ; Armstrong, Gregory ; Ness, Kirsten K. ; Srivastava, Deokumar ; Donovan, F. Daniel ; Kurt, Beth A. ; Metzger, Monika L. ; Krasin, Matthew J. ; Joshi, Vijaya ; Durand, Jean Bernard ; Robison, Leslie L. ; Hudson, Melissa M. ; Flamm, Scott D. / Coronary artery disease detected by coronary computed tomography angiography in adult survivors of childhood Hodgkin lymphoma. In: Cancer. 2014 ; Vol. 120, No. 22. pp. 3536-3544.
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title = "Coronary artery disease detected by coronary computed tomography angiography in adult survivors of childhood Hodgkin lymphoma",
abstract = "BACKGROUND: Survivors of Hodgkin lymphoma (HL) have significant cardiovascular risk and require long-term surveillance. The current study assessed the prevalence of coronary artery disease (CAD) by coronary computed tomography angiography (CCTA) in adult survivors of childhood HL. METHODS: Thirty-one survivors of HL, 13 of whom (42{\%}) were treated with radiotherapy (RT) only and 18 of whom (58{\%}) were treated with multimodal therapy, underwent CCTA, echocardiography, electrocardiography (ECG), and treadmill stress testing. Obstructive CAD was defined as ≥50{\%} occlusion of the left main or ≥70{\%} occlusion of the left anterior descending, left circumflex, or right coronary arteries on CCTA. Echocardiograms with resting wall motion abnormalities or an ejection fraction <50{\%}; ECGs with Q waves, ST abnormalities without Q waves, or T-wave abnormalities without Q waves; and a J-point depression of ≥1 mm with a horizontal or downsloping ST segment on stress testing were considered abnormal. RESULTS: The prevalence of disease in participants (median age, 40 years [range, 26 years-55 years]; median time from cancer diagnosis, 24 years [range, 17 years-39 years]) was 39{\%}, with 39 plaques detected among 12 survivors. Three participants (10{\%}) treated with RT only had 4 obstructive lesions; 9 patients (29{\%}; 5 of whom were treated with RT only and 4 of whom were treated with multimodal therapy) had nonobstructive lesions. Approximately 15{\%} of lesions involved the left main, 21{\%} involved the proximal left anterior descending, 18{\%} involved the proximal right coronary, and 13{\%} involved the proximal left circumflex arteries. Of the 12 participants found to have CAD by CCTA, 7 had a positive ECG, 1 had a positive echocardiogram, and 1 had a positive stress test. CONCLUSIONS: CCTA identified CAD in a substantial percentage of survivors of HL and may be an effective screening modality for this population. Cancer 2014;120:3536–3544.",
author = "Mulrooney, {Daniel A.} and Nunnery, {Sara E.} and Gregory Armstrong and Ness, {Kirsten K.} and Deokumar Srivastava and Donovan, {F. Daniel} and Kurt, {Beth A.} and Metzger, {Monika L.} and Krasin, {Matthew J.} and Vijaya Joshi and Durand, {Jean Bernard} and Robison, {Leslie L.} and Hudson, {Melissa M.} and Flamm, {Scott D.}",
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T1 - Coronary artery disease detected by coronary computed tomography angiography in adult survivors of childhood Hodgkin lymphoma

AU - Mulrooney, Daniel A.

AU - Nunnery, Sara E.

AU - Armstrong, Gregory

AU - Ness, Kirsten K.

AU - Srivastava, Deokumar

AU - Donovan, F. Daniel

AU - Kurt, Beth A.

AU - Metzger, Monika L.

AU - Krasin, Matthew J.

AU - Joshi, Vijaya

AU - Durand, Jean Bernard

AU - Robison, Leslie L.

AU - Hudson, Melissa M.

AU - Flamm, Scott D.

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N2 - BACKGROUND: Survivors of Hodgkin lymphoma (HL) have significant cardiovascular risk and require long-term surveillance. The current study assessed the prevalence of coronary artery disease (CAD) by coronary computed tomography angiography (CCTA) in adult survivors of childhood HL. METHODS: Thirty-one survivors of HL, 13 of whom (42%) were treated with radiotherapy (RT) only and 18 of whom (58%) were treated with multimodal therapy, underwent CCTA, echocardiography, electrocardiography (ECG), and treadmill stress testing. Obstructive CAD was defined as ≥50% occlusion of the left main or ≥70% occlusion of the left anterior descending, left circumflex, or right coronary arteries on CCTA. Echocardiograms with resting wall motion abnormalities or an ejection fraction <50%; ECGs with Q waves, ST abnormalities without Q waves, or T-wave abnormalities without Q waves; and a J-point depression of ≥1 mm with a horizontal or downsloping ST segment on stress testing were considered abnormal. RESULTS: The prevalence of disease in participants (median age, 40 years [range, 26 years-55 years]; median time from cancer diagnosis, 24 years [range, 17 years-39 years]) was 39%, with 39 plaques detected among 12 survivors. Three participants (10%) treated with RT only had 4 obstructive lesions; 9 patients (29%; 5 of whom were treated with RT only and 4 of whom were treated with multimodal therapy) had nonobstructive lesions. Approximately 15% of lesions involved the left main, 21% involved the proximal left anterior descending, 18% involved the proximal right coronary, and 13% involved the proximal left circumflex arteries. Of the 12 participants found to have CAD by CCTA, 7 had a positive ECG, 1 had a positive echocardiogram, and 1 had a positive stress test. CONCLUSIONS: CCTA identified CAD in a substantial percentage of survivors of HL and may be an effective screening modality for this population. Cancer 2014;120:3536–3544.

AB - BACKGROUND: Survivors of Hodgkin lymphoma (HL) have significant cardiovascular risk and require long-term surveillance. The current study assessed the prevalence of coronary artery disease (CAD) by coronary computed tomography angiography (CCTA) in adult survivors of childhood HL. METHODS: Thirty-one survivors of HL, 13 of whom (42%) were treated with radiotherapy (RT) only and 18 of whom (58%) were treated with multimodal therapy, underwent CCTA, echocardiography, electrocardiography (ECG), and treadmill stress testing. Obstructive CAD was defined as ≥50% occlusion of the left main or ≥70% occlusion of the left anterior descending, left circumflex, or right coronary arteries on CCTA. Echocardiograms with resting wall motion abnormalities or an ejection fraction <50%; ECGs with Q waves, ST abnormalities without Q waves, or T-wave abnormalities without Q waves; and a J-point depression of ≥1 mm with a horizontal or downsloping ST segment on stress testing were considered abnormal. RESULTS: The prevalence of disease in participants (median age, 40 years [range, 26 years-55 years]; median time from cancer diagnosis, 24 years [range, 17 years-39 years]) was 39%, with 39 plaques detected among 12 survivors. Three participants (10%) treated with RT only had 4 obstructive lesions; 9 patients (29%; 5 of whom were treated with RT only and 4 of whom were treated with multimodal therapy) had nonobstructive lesions. Approximately 15% of lesions involved the left main, 21% involved the proximal left anterior descending, 18% involved the proximal right coronary, and 13% involved the proximal left circumflex arteries. Of the 12 participants found to have CAD by CCTA, 7 had a positive ECG, 1 had a positive echocardiogram, and 1 had a positive stress test. CONCLUSIONS: CCTA identified CAD in a substantial percentage of survivors of HL and may be an effective screening modality for this population. Cancer 2014;120:3536–3544.

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