Relation of Coronary Artery Calcium Score to Premature Coronary Artery Disease in Survivors >15 Years of Hodgkin's Lymphoma

Andersen, Rune; Wethal, Torgeir; Günther, Anne; Fosså, Alexander; Edvardsen, Thor; Fosså, Sophie D.; Kjekshus, John

doi:10.1016/j.amjcard.2009.09.005

« Previous Next »American Journal of Cardiology
Volume 105, Issue 2 , Pages 149-152, 15 January 2010

Relation of Coronary Artery Calcium Score to Premature Coronary Artery Disease in Survivors >15 Years of Hodgkin's Lymphoma

Rune Andersen, MD
- Deprtment of Radiology, Oslo University Hospital, University of Oslo, Oslo, Norway
- Corresponding author: Tel: 47-23-07-00-00; fax: +47-23-07-26-10
- Dr. Andersen and Dr. Wethal contributed equally to this article.
Torgeir Wethal, MD
- Deprtment of Cardiology, Oslo University Hospital, University of Oslo, Oslo, Norway
- Dr. Andersen and Dr. Wethal contributed equally to this article.
Anne Günther, MD
- Deprtment of Radiology, Oslo University Hospital, University of Oslo, Oslo, Norway
Alexander Fosså, PhD
- Cancer Clinic, Rikshospitalet, Oslo University Hospital, University of Oslo, Oslo, Norway
Thor Edvardsen, PhD
- Deprtment of Cardiology, Oslo University Hospital, University of Oslo, Oslo, Norway
Sophie D. Fosså, PhD
- Department of Clinical Cancer Research, Faculty Division Rikshospitalet, University of Oslo, Oslo, Norway
John Kjekshus, PhD
- Deprtment of Cardiology, Oslo University Hospital, University of Oslo, Oslo, Norway

Received 7 June 2009; received in revised form 4 September 2009; accepted 4 September 2009. published online 16 November 2009.

Long-term survival in Hodgkin lymphoma (HL) survivors is complicated by an increased risk for coronary artery disease (CAD) due to radiation-induced endothelial damage. Our objective was to quantify total coronary artery calcium (CAC) in long-term HL survivors who had survived ≥15 years after treatment and relate it to the presence of verified CAD. Forty-seven HL survivors 50 ± 7 years of age who had survived 22 ± 3 years after mediastinal radiotherapy underwent CAC scoring (Agatston and volume scores) in a multidetector computed tomographic scanner. Total volume score was higher in 7 patients (15%) with verified CAD (median 439, range 8 to 2,057) compared to those without (median 68, 0 to 767, p = 0.022). Ten patients had CAC scores >200. Of these 10, 5 had undergone revascularization of coronary arteries. None of the 8 patients with a CAC score 0 had symptomatic CAD. In conclusion, postirradiation CAC can be quantified by CAC score and this may be a simple and suitable method to screen for CAD in long-term HL survivors. Patients with a CAC score >200 often have clinically significant CAD, and further investigation including angiography may be justified. Lower CAC scores, however, do not exclude CAD and further studies should be undertaken to define the best algorithm for follow-up of this patient group.