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.
authors.affiliation: Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee; Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, Tennessee; Department of Pediatrics, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee; Department of Medicine, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Mulrooney
authors.forename: Sara E
authors.initials: SE
authors.lastname: Nunnery
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Armstrong
authors.forename: Kirsten K
authors.initials: KK
authors.lastname: Ness
authors.forename: Deokumar
authors.initials: D
authors.lastname: Srivastava
authors.forename: F Daniel
authors.initials: FD
authors.lastname: Donovan
authors.forename: Beth A
authors.initials: BA
authors.lastname: Kurt
authors.forename: Monika L
authors.initials: ML
authors.lastname: Metzger
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Krasin
authors.forename: Vijaya
authors.initials: V
authors.lastname: Joshi
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Durand
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
authors.forename: Scott D
authors.initials: SD
authors.lastname: Flamm
mesh_terms: D000328:Adult; D002648:Child; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D004562:Electrocardiography; D006689:Hodgkin Disease / Q000150:complications* / Q000401:mortality; D006801:Humans; D008875:Middle Aged; D017741:Survivors; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Hodgkin lymphoma; cardiovascular; computed tomography angiography; coronary artery disease; radiotherapy