title: Prospective coronary heart disease screening in asymptomatic Hodgkin lymphoma patients using coronary computed tomography angiography: results and risk factor analysis.
abstract: OBJECTIVE
  To prospectively investigate the coronary artery status using coronary CT angiography (CCTA) in patients with Hodgkin lymphoma treated with combined modalities and mediastinal irradiation.
  
  
  METHODS
  All consecutive asymptomatic patients with Hodgkin lymphoma entered the study during follow-up, from August 2007 to May 2012. Coronary CT angiography was performed, and risk factors were recorded along with leukocyte telomere length (LTL) measurements.
  
  
  RESULTS
  One hundred seventy-nine patients entered the 5-year study. The median follow-up was 11.6 years (range, 2.1-40.2 years), and the median interval between treatment and the CCTA was 9.5 years (range, 0.5-40 years). Coronary artery abnormalities were demonstrated in 46 patients (26%). Coronary CT angiography abnormalities were detected in nearly 15% of the patients within the first 5 years after treatment. A significant increase (34%) occurred 10 years after treatment (P=.05). Stenoses were mostly nonostial. Severe stenoses were observed in 12 (6.7%) of the patients, entailing surgery with either angioplasty with stent placement or bypass grafting in 10 of them (5.5%). A multivariate analysis demonstrated that age at treatment, hypertension, and hypercholesterolemia, as well as radiation dose to the coronary artery origins, were prognostic factors. In the group of patients with LTL measurements, hypertension and LTL were the only independent risk factors.
  
  
  CONCLUSIONS
  The findings suggest that CCTA can identify asymptomatic individuals at risk of acute coronary artery disease who might require either preventive or curative measures. Conventional risk factors and the radiation dose to coronary artery origins were independent prognostic factors. The prognostic value of LTL needs further investigation.
authors.affiliation: Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France. Electronic address: girinsky.theodore@orange.fr.
authors.forename: Theodore
authors.initials: T
authors.lastname: Girinsky
authors.affiliation: Laboratory of Radiobiology and Oncology, Institut de Radiobiologie Cellulaire et Moleculaire/Direction des Sciences Vivantes/Commissariat Energie Atomique, Fontenay aux Roses, France.
authors.forename: Radhia
authors.initials: R
authors.lastname: M'Kacher
authors.affiliation: Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Lessard
authors.affiliation: Biostatistics and Epidemiology Unit, Institut Gustave Roussy, Villejuif, France.
authors.forename: Serge
authors.initials: S
authors.lastname: Koscielny
authors.affiliation: Department of Radiology, Marie Lannelongue, Chatenay-Malabry, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Elfassy
authors.affiliation: Department of Radiology, Marie Lannelongue, Chatenay-Malabry, France.
authors.forename: François
authors.initials: F
authors.lastname: Raoux
authors.affiliation: Department of Hematology, Institut Gustave Roussy, Villejuif, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Carde
authors.affiliation: Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France.
authors.forename: Marcos Dos
authors.initials: MD
authors.lastname: Santos
authors.affiliation: Department of Head and Neck Surgery, Institut Gustave Roussy, Villejuif, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Margainaud
authors.affiliation: Laboratory of Radiobiology and Oncology, Institut de Radiobiologie Cellulaire et Moleculaire/Direction des Sciences Vivantes/Commissariat Energie Atomique, Fontenay aux Roses, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Sabatier
authors.affiliation: Department of Radiation Oncology, Institut Gustave Roussy, Villejuif, France.
authors.forename: Mithra
authors.initials: M
authors.lastname: Ghalibafian
authors.affiliation: Department of Radiology, Marie Lannelongue, Chatenay-Malabry, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Paul
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D000970:Antineoplastic Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000009:adverse effects / Q000379:methods; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality / Q000628:therapy; D004317:Doxorubicin / Q000627:therapeutic use; D005163:Factor Analysis, Statistical; D005260:Female; D006689:Hodgkin Disease / Q000628:therapy*; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications; D006973:Hypertension / Q000150:complications; D007962:Leukocytes; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D012307:Risk Factors; D033581:Stem Cell Transplantation; D016615:Telomere; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents; D004317:Doxorubicin